Healthcare Provider Details

I. General information

NPI: 1265519870
Provider Name (Legal Business Name): SANTOSH K GANESH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WINDSOR DR SUITE 103
COLD SPRING KY
41076-2026
US

IV. Provider business mailing address

1010 WINDSOR DR STE 103
COLD SPRING KY
41076-2026
US

V. Phone/Fax

Practice location:
  • Phone: 859-279-3228
  • Fax: 859-251-5114
Mailing address:
  • Phone: 859-279-3228
  • Fax: 859-251-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4684
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4684
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: