Healthcare Provider Details

I. General information

NPI: 1962645614
Provider Name (Legal Business Name): HANDS ON HEALING CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TODDS RD SUITE 110
LEXINGTON KY
40509-1325
US

IV. Provider business mailing address

3100 TODDS RD SUITE 110
LEXINGTON KY
40509-1325
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-8833
  • Fax:
Mailing address:
  • Phone: 859-263-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5077
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5038
License Number StateKY

VIII. Authorized Official

Name: DR. MICHAEL L SULLIVAN
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 859-263-8833