Healthcare Provider Details

I. General information

NPI: 1023197712
Provider Name (Legal Business Name): S & P CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 BARDSTOWN RD
LOUISVILLE KY
40291-3439
US

IV. Provider business mailing address

8015 BARDSTOWN RD
LOUISVILLE KY
40291-3439
US

V. Phone/Fax

Practice location:
  • Phone: 502-239-3993
  • Fax: 502-239-3939
Mailing address:
  • Phone: 502-239-3993
  • Fax: 502-239-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4988
License Number StateKY

VIII. Authorized Official

Name: MS. THERESA LEWIS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 502-239-3993