Healthcare Provider Details

I. General information

NPI: 1396806220
Provider Name (Legal Business Name): STEVEN MICHAEL VIOLA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487N. BARDSTOWN ROAD
MT.WASHINGTON KY
40047
US

IV. Provider business mailing address

13100 TRUMP AVE
LOUISVILLE KY
40299-8354
US

V. Phone/Fax

Practice location:
  • Phone: 502-955-9111
  • Fax: 502-955-9111
Mailing address:
  • Phone: 502-240-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4171
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: