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General NPI Number Information
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NPI Number | 1548574494
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC, PSC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 111 W HIGHWAY 80 STE B
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City | SOMERSET
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State | KY
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Zip | 42503-2725
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Country | US
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Telephone | 606-676-0040
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Fax | 606-676-0641
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Provider Business Mailing Address
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Address Line | 111 W HIGHWAY 80 STE. B
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City | SOMERSET
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State | KY
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Zip | 42503-2725
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Country | US
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Telephone | 606-676-0040
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Fax | 606-676-0641
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Authorized Official
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Title or Position | OWNER/
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Name | MATTHEW MICHAEL TRUE
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Credential | DC
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Telephone | 606-676-0040
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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 | 4917
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License Number State | KY
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