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General NPI Number Information
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NPI Number | 1952768756
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Entity Type | Organization
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Legal Business Name | TOTAL BODY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 10232 SHELBYVILLE RD SUITE 1A
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City | LOUISVILLE
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State | KY
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Zip | 40223-2978
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Country | US
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Telephone | 502-785-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 10232 SHELBYVILLE RD SUITE 1A
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City | LOUISVILLE
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State | KY
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Zip | 40223-2978
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Country | US
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Telephone | 502-785-4641
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JILLIAN R PORTER
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Credential | DC
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Telephone | 812-431-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 5475
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License Number State | KY
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