Healthcare Provider Details

I. General information

NPI: 1891388310
Provider Name (Legal Business Name): CHIROPRACTIC REHAB AND SPORTS INJURIES OF LOUISVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 FLINTLOCK DR
LOUISVILLE KY
40216-1534
US

IV. Provider business mailing address

4106 FLINTLOCK DR
LOUISVILLE KY
40216-1534
US

V. Phone/Fax

Practice location:
  • Phone: 502-290-7361
  • Fax: 502-688-6468
Mailing address:
  • Phone:
  • Fax: 502-688-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL L YOUNG
Title or Position: OWNER
Credential: DC
Phone: 606-564-4213