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General NPI Number Information
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NPI Number | 1770541955
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Entity Type | Organization
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Legal Business Name | JEFFERSONTOWN CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 10131 TAYLORSVILLE RD
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-3649
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Country | US
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Telephone | 502-267-6444
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Fax | 502-267-6445
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Provider Business Mailing Address
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Address Line | 10131 TAYLORSVILLE RD
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-3649
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Country | US
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Telephone | 502-267-6444
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Fax | 502-267-6445
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. CRAIG WILLIAM PFEFFER
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Credential | DC
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Telephone | 502-267-6444
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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 | 3812
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License Number State | KY
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