MEDICARE: NICHOLASVILLE FAMILY CHIROPRACTIC

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

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	:	1720552334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLASVILLE FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	457 KEENE CENTRE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-1492
Country	:	US
Telephone Number	:	859-241-6003
Fax Number	:	859-241-6071

Provider Business Practice Location Address
First Line	:	457 KEENE CENTRE DR
Second Line	:
City	:	NICHOLASVILLE
State	:	KY
Zip	:	40356-1492
Country	:	US
Telephone Number	:	592-416-0038
Fax Number	:	859-241-6071

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	TOSHA MCCORMACK
Credential	:
Telephone Number	:	859-408-5440

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	10/06/2022

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