Healthcare Provider Details

I. General information

NPI: 1730600255
Provider Name (Legal Business Name): FOUNDATION CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 HIGHWAY 121 BYP N STE B
MURRAY KY
42071-8759
US

IV. Provider business mailing address

1601 HIGHWAY 121 BYP N STE B
MURRAY KY
42071-8759
US

V. Phone/Fax

Practice location:
  • Phone: 270-917-2225
  • Fax:
Mailing address:
  • Phone: 270-917-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY CHASE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 270-761-1945