Healthcare Provider Details

I. General information

NPI: 1629126347
Provider Name (Legal Business Name): TAYLOR COUNTY CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GREENBRIAR DR
CAMPBELLSVILLE KY
42718-9613
US

IV. Provider business mailing address

100 GREENBRIAR DR
CAMPBELLSVILLE KY
42718-9613
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-5200
  • Fax:
Mailing address:
  • Phone: 270-465-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5035
License Number StateKY

VIII. Authorized Official

Name: JANNA L GRESHAM
Title or Position: OWNER
Credential: DC
Phone: 270-465-5200