MEDICARE: DR. ANTHONY VICTOR BASTECKI D.C.

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	3946	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	:	1790819209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY VICTOR BASTECKI D.C.

Provider Business Mailing Address
First Line	:	4750 HARTLAND PKWY
Second Line	:	SUITE 200
City	:	LEXINGTON
State	:	KY
Zip	:	40515-1558
Country	:	US
Telephone Number	:	859-266-2223
Fax Number	:	859-266-4926

Provider Business Practice Location Address
First Line	:	4750 HARTLAND PKWY
Second Line	:	SUITE 200
City	:	LEXINGTON
State	:	KY
Zip	:	40515-1558
Country	:	US
Telephone Number	:	859-266-2223
Fax Number	:	859-266-4926

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/31/2015

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