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General NPI Number Information
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NPI Number | 1073817987
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Entity Type | Organization
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Legal Business Name | SHELBY STREET CHIROPRACTIC & INJURY REHAB PSC
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 802 E BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40204-1053
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Country | US
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Telephone | 502-583-8767
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Fax | 502-583-5770
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Provider Business Mailing Address
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Address Line | 802 E BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40204-1053
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Country | US
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Telephone | 502-583-8767
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Fax | 502-583-5770
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MICHAEL CLOVER
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Credential |
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Telephone | 502-386-1594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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