Healthcare Provider Details

I. General information

NPI: 1205004736
Provider Name (Legal Business Name): AMERICAN HEALTH CENTERS OF GRAYSON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 INTERSTATE DR
GRAYSON KY
41143-1787
US

IV. Provider business mailing address

103 THELMA AVE
SOUTH POINT OH
45680-9203
US

V. Phone/Fax

Practice location:
  • Phone: 740-646-7321
  • Fax:
Mailing address:
  • Phone: 740-646-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4440
License Number StateKY

VIII. Authorized Official

Name: MRS. HOLLY DAWN LAWSON
Title or Position: BILLING MANAGER
Credential:
Phone: 740-646-7321