Healthcare Provider Details

I. General information

NPI: 1124267604
Provider Name (Legal Business Name): HANDS ON HEALING CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 E HIGH ST SUITE 230
LEXINGTON KY
40502-2156
US

IV. Provider business mailing address

867 E HIGH ST SUITE 230
LEXINGTON KY
40502-2156
US

V. Phone/Fax

Practice location:
  • Phone: 859-268-7501
  • Fax:
Mailing address:
  • Phone: 859-268-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5038
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5077
License Number StateKY

VIII. Authorized Official

Name: BETHANY LEE VAN ROOY
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 859-268-7501