Healthcare Provider Details

I. General information

NPI: 1407944606
Provider Name (Legal Business Name): JOHN R KRAWCHISON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 TAYLOR BLVD
LOUISVILLE KY
40215-2371
US

IV. Provider business mailing address

4107 TAYLOR BLVD
LOUISVILLE KY
40215-2371
US

V. Phone/Fax

Practice location:
  • Phone: 502-364-7246
  • Fax: 502-364-7245
Mailing address:
  • Phone: 502-364-7246
  • Fax: 502-364-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberIN08001209
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberIN08001209
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3897
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: