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General NPI Number Information
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NPI Number | 1396068268
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Entity Type | Organization
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Legal Business Name | BASIC HEALTH CHIROPRACTIC AND REHAB
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 5915 MERCHANTS STREET
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City | FLORENCE
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State | KY
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Zip | 41024
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Country | US
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Telephone | 859-525-1695
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Fax | 859-525-0169
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Provider Business Mailing Address
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Address Line | 5915 MERCHANTS STREET
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City | FLORENCE
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State | KY
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Zip | 41024
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Country | US
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Telephone | 859-525-1695
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Fax | 859-525-0169
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. RAYMOND RUSSELL UHLMANSIEK
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Credential | D.C.
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Telephone | 859-525-1695
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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 | 4988
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License Number State | KY
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