MEDICARE: MARC ANTHONY BOBROW DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5084	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306088653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC ANTHONY BOBROW DC

Provider Business Mailing Address
First Line	:	5209 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-1758
Country	:	US
Telephone Number	:	502-995-0099
Fax Number	:	502-449-1280

Provider Business Practice Location Address
First Line	:	5209 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-1758
Country	:	US
Telephone Number	:	502-995-0099
Fax Number	:	502-449-1280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	08/25/2015

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Directions to “ MARC ANTHONY BOBROW DC” Practice Location

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