Healthcare Provider Details

I. General information

NPI: 1619642535
Provider Name (Legal Business Name): BARDSTOWN THERAPY & CHIRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 BARDSTOWN RD STE 318
LOUISVILLE KY
40218-3281
US

IV. Provider business mailing address

4229 BARDSTOWN RD STE 318
LOUISVILLE KY
40218-3281
US

V. Phone/Fax

Practice location:
  • Phone: 502-963-1955
  • Fax:
Mailing address:
  • Phone: 502-963-1955
  • 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: GIANNYS MATO
Title or Position: PRESIDENT
Credential: LMT
Phone: 502-963-1955