Healthcare Provider Details

I. General information

NPI: 1447360664
Provider Name (Legal Business Name): JOHN GERARD RESTAINO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 PARK RD SUITE 21
FT WRIGHT KY
41011
US

IV. Provider business mailing address

1671 PARK RD SUITE 21
FT WRIGHT KY
41011
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-8778
  • Fax: 859-578-8777
Mailing address:
  • Phone: 859-578-8778
  • Fax: 859-578-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4304
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: