Healthcare Provider Details

I. General information

NPI: 1104962596
Provider Name (Legal Business Name): PRIMARY CARE CHIROPRACTIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 PARIS RD STE 341
MAYFIELD KY
42066-3306
US

IV. Provider business mailing address

1011 PARIS RD STE 341
MAYFIELD KY
42066-3306
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-0907
  • Fax: 270-251-0908
Mailing address:
  • Phone: 270-251-0907
  • Fax: 270-251-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4685
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4685
License Number StateKY

VIII. Authorized Official

Name: DR. DANIEL RICHARD FARR
Title or Position: PRESIDENT
Credential: DC
Phone: 270-251-0907