Healthcare Provider Details

I. General information

NPI: 1265758254
Provider Name (Legal Business Name): HEBRON CHIROPRACTIC II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 NORTHSIDE DR
HEBRON KY
41048-7195
US

IV. Provider business mailing address

2030 NORTHSIDE DR
HEBRON KY
41048-7195
US

V. Phone/Fax

Practice location:
  • Phone: 859-372-0888
  • Fax: 206-333-1232
Mailing address:
  • Phone: 859-372-0888
  • Fax: 206-333-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN JAY LANGLEY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 859-308-2034