Healthcare Provider Details

I. General information

NPI: 1497387864
Provider Name (Legal Business Name): CENTRAL CITY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 W EVERLY BROTHERS BLVD
CENTRAL CITY KY
42330-1833
US

IV. Provider business mailing address

1731 W EVERLY BROTHERS BLVD
CENTRAL CITY KY
42330-1833
US

V. Phone/Fax

Practice location:
  • Phone: 270-754-1335
  • Fax: 270-757-9478
Mailing address:
  • Phone: 270-754-1335
  • Fax: 270-757-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD WAYNE JOINES II
Title or Position: SOLE MBR
Credential: DC
Phone: 270-754-1335