Healthcare Provider Details

I. General information

NPI: 1699980383
Provider Name (Legal Business Name): CAMPBELLSBURG CHIROPRACTIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8172 MAIN ST
CAMPBELLSBURG KY
40011-0293
US

IV. Provider business mailing address

8172 MAIN ST PO BOX 293
CAMPBELLSBURG KY
40011-0293
US

V. Phone/Fax

Practice location:
  • Phone: 502-532-0099
  • Fax: 502-532-0096
Mailing address:
  • Phone: 502-532-0099
  • Fax: 502-532-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4721
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4721
License Number StateKY

VIII. Authorized Official

Name: DR. MARK EVERETT HINES
Title or Position: OWNER
Credential: DC
Phone: 502-532-0099