Healthcare Provider Details

I. General information

NPI: 1548887086
Provider Name (Legal Business Name): NECK BACK & KNEE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 US 42 STE A
FLORENCE KY
41042-1908
US

IV. Provider business mailing address

7560 US 42 STE A
FLORENCE KY
41042-1908
US

V. Phone/Fax

Practice location:
  • Phone: 859-283-2475
  • Fax:
Mailing address:
  • Phone: 859-283-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DAMMEL
Title or Position: OWNER
Credential: MD
Phone: 859-283-2475