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General NPI Number Information
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NPI Number | 1639616253
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Entity Type | Organization
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Legal Business Name | LEBANON CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 496 W MAIN ST
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City | LEBANON
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State | KY
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Zip | 40033-1362
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Country | US
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Telephone | 270-692-6555
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Fax | 270-692-5751
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Provider Business Mailing Address
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Address Line | 496 W MAIN ST
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City | LEBANON
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State | KY
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Zip | 40033-1362
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Country | US
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Telephone | 270-692-6555
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Fax | 270-692-5751
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JEFFREY ROBERTS
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Credential | D.C.
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Telephone | 270-692-6555
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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 | 4427
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License Number State | KY
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