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General NPI Number Information
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NPI Number | 1457811366
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Entity Type | Organization
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Legal Business Name | TRU ATHLETIC PERFORMANCE PLLC
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 2240 TAYLORSVILLE RD #5295
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City | LOUISVILLE
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State | KY
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Zip | 40255-4011
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Country | US
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Telephone | 502-684-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 TAYLORSVILLE RD #5295
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City | LOUISVILLE
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State | KY
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Zip | 40255-4011
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Country | US
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Telephone | 502-684-3115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. COURTNEY BROOKE WELLS
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Credential | DC
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Telephone | 502-684-3115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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