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General NPI Number Information
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NPI Number | 1902461692
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Entity Type | Organization
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Legal Business Name | LOUISVILLE INJURY CLINICS, INC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 4400 BRECKENRIDGE LANE SUITE 102
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City | LOUISVILLE
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State | KY
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Zip | 40218
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Country | US
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Telephone | 502-632-2646
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Fax | 502-632-2747
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Provider Business Mailing Address
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Address Line | 3044 BARDSTOWN RD PO BOX 241 SUITE 241
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City | LOUISVILLE
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State | KY
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Zip | 40205
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Country | US
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Telephone | 502-753-3727
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Fax | 502-753-3728
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. GREGORY A BRONNER
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Credential | DO
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Telephone | 727-433-4734
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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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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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