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General NPI Number Information
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NPI Number | 1194261750
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Entity Type | Organization
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Legal Business Name | ELITE PERFORMANCE & INDIVIDUALIZED CARE CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 1300 E NEW CIRCLE RD STE 160
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City | LEXINGTON
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State | KY
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Zip | 40505
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Country | US
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Telephone | 859-255-3777
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Fax | 859-255-3967
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Provider Business Mailing Address
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Address Line | 1300 E NEW CIRCLE RD STE. 160
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City | LEXINGTON
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State | KY
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Zip | 40505
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Country | US
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Telephone | 859-255-3777
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Fax | 859-255-3967
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Authorized Official
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Title or Position | SOLE MEMEBER
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Name | DR. RICHARD JOSEPH SIMPSON
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Credential | DC
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Telephone | 859-255-3777
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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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