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General NPI Number Information
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NPI Number | 1104081306
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF SOUTHEAST LEXINGTON INC.
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 4101 TATES CREEK CENTRE DR SUITE 132
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City | LEXINGTON
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State | KY
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Zip | 40517-3066
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Country | US
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Telephone | 859-272-5460
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Fax | 859-272-5463
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Provider Business Mailing Address
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Address Line | 4101 TATES CREEK CENTRE DR SUITE 132
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City | LEXINGTON
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State | KY
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Zip | 40517-3066
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Country | US
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Telephone | 859-272-5460
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Fax | 859-272-5463
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MICHAEL NEWELL PUGH
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Credential | D.C.
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Telephone | 859-272-5460
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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 | 4578
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License Number State | KY
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