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General NPI Number Information
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NPI Number | 1700052644
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Entity Type | Organization
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Legal Business Name | SOUTHGATE CHIROPRACTIC INC.
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 2306 ALEXANDRIA PIKE
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City | SOUTHGATE
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State | KY
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Zip | 41071-3234
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Country | US
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Telephone | 859-572-0029
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Fax | 859-572-0263
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Provider Business Mailing Address
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Address Line | 2306 ALEXANDRIA PIKE
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City | SOUTHGATE
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State | KY
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Zip | 41071-3234
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Country | US
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Telephone | 859-572-0029
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Fax | 859-572-0263
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | ROGER CHRISTOPHER JONES
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Credential | D.C.
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Telephone | 859-572-0029
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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 | 4453
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License Number State | KY
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