Healthcare Provider Details

I. General information

NPI: 1942110895
Provider Name (Legal Business Name): SAVANNAH LEIMOMI O'BANION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 LICKING PIKE STE B
WILDER KY
41071-3046
US

IV. Provider business mailing address

6 5TH AVE
HIGHLAND HEIGHTS KY
41076-1310
US

V. Phone/Fax

Practice location:
  • Phone: 859-360-0664
  • Fax: 859-360-3143
Mailing address:
  • Phone: 502-294-2118
  • Fax: 859-360-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number311213
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: