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General NPI Number Information
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NPI Number | 1548430747
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Entity Type | Organization
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Legal Business Name | CRACKERBACK, INC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 1679 OLD PRESTON HWY N SUITE 6
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City | LOUISVILLE
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State | KY
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Zip | 40229-3297
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Country | US
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Telephone | 502-957-1021
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Fax | 502-957-1703
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Provider Business Mailing Address
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Address Line | 1679 OLD PRESTON HWY N SUITE 6
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City | LOUISVILLE
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State | KY
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Zip | 40229-3297
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Country | US
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Telephone | 502-957-1021
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Fax | 502-957-1703
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Authorized Official
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Title or Position | PRESIDENT
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Name | RODRICK C HAHN
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Credential | D.C.
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Telephone | 502-957-1021
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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 | 4365
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License Number State | KY
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