MEDICARE: VALLEY STATION CHIROPRACTIC & REHAB,PLLC

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	4228	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

General Provider Information

NPI Number	:	1316280688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY STATION CHIROPRACTIC & REHAB,PLLC

Provider Business Mailing Address
First Line	:	10400 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-5913
Country	:	US
Telephone Number	:	502-933-2005
Fax Number	:	502-933-2074

Provider Business Practice Location Address
First Line	:	10400 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-5913
Country	:	US
Telephone Number	:	502-933-2005
Fax Number	:	502-933-2074

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL GRASS
Credential	:	DC
Telephone Number	:	502-933-2005

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	06/10/2013

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