Healthcare Provider Details

I. General information

NPI: 1083073381
Provider Name (Legal Business Name): COMMUNITY CARE CHIROPRACTIC CENTER, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 GILMORE LN
LOUISVILLE KY
40213-2307
US

IV. Provider business mailing address

1227 GILMORE LN
LOUISVILLE KY
40213-2307
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOHN R KRAWCHISON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 502-364-7246