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General NPI Number Information
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NPI Number | 1699386433
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Entity Type | Organization
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Legal Business Name | DAWSON SPINE & SPORT CHIROPRACTIC, INC
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 410 W JEFFERSON ST
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City | LA GRANGE
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State | KY
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Zip | 40031-1114
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Country | US
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Telephone | 502-465-0055
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Fax | 502-265-1215
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Provider Business Mailing Address
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Address Line | 410 W JEFFERSON ST
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City | LA GRANGE
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State | KY
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Zip | 40031-1114
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Country | US
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Telephone | 502-465-0055
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Fax | 502-265-1215
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Authorized Official
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Title or Position | OWNER/DO
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Name | BRENT M DAWSON
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Credential | DO
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Telephone | 502-465-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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