Healthcare Provider Details

I. General information

NPI: 1295042034
Provider Name (Legal Business Name): DIXIE CHIROPRACTIC & REHABILITATION, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 DIXIE HWY STE 25
LOUISVILLE KY
40216-1771
US

IV. Provider business mailing address

5135 DIXIE HWY STE 25
LOUISVILLE KY
40216-1771
US

V. Phone/Fax

Practice location:
  • Phone: 502-449-5046
  • Fax: 502-449-5048
Mailing address:
  • Phone: 502-449-5046
  • Fax: 502-449-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY ROSUM
Title or Position: CHIROPRACTOR
Credential:
Phone: 502-449-5046