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General NPI Number Information
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NPI Number | 1629166632
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Entity Type | Organization
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Legal Business Name | KENTUCKY FAMILY CHIROPRACTIC EAST LOUISVILLE PSC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 291 N HUBBARDS LN SUITE A22
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City | LOUISVILLE
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State | KY
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Zip | 40207-2295
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Country | US
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Telephone | 502-893-8873
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Fax | 502-893-8847
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Provider Business Mailing Address
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Address Line | 291 N HUBBARDS LN SUITE A22
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City | LOUISVILLE
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State | KY
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Zip | 40207-2295
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Country | US
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Telephone | 502-893-8873
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Fax | 502-893-8847
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID N CAMPOLA
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Credential | DC
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Telephone | 502-893-8873
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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 | 4444
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License Number State | KY
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