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General NPI Number Information
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NPI Number | 1093851453
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Entity Type | Organization
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Legal Business Name | GRAYSON CHIROPRACTIC CENTER PSC INC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 308 HORTON ST SUITE # 2
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City | GRAYSON
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State | KY
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Zip | 41143
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Country | US
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Telephone | 606-474-6445
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Fax | 606-474-6445
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Provider Business Mailing Address
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Address Line | 308 HORTON ST SUITE # 2
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City | GRAYSON
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State | KY
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Zip | 41143-1319
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Country | US
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Telephone | 606-474-6445
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Fax | 606-474-6445
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Authorized Official
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Title or Position | OWNER
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Name | JOHN DOLF FISCHER
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Credential | D.C.
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Telephone | 606-474-6445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4234
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License Number State | KY
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