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General NPI Number Information
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NPI Number | 1689851602
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Entity Type | Organization
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Legal Business Name | OLDHAM COUNTY SPINE & REHAB CENTER PSC
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 301 S 1ST ST
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City | LAGRANGE
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State | KY
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Zip | 40031-1240
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Country | US
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Telephone | 502-222-0000
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Fax | 502-222-3488
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Provider Business Mailing Address
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Address Line | 301 S 1ST ST
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City | LAGRANGE
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State | KY
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Zip | 40031-1240
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Country | US
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Telephone | 502-222-0000
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Fax | 502-222-3488
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Authorized Official
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Title or Position | OWNER
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Name | LIDO LEE PETRUCCI
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Credential | DC
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Telephone | 502-222-0000
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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 |
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License Number State |
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