MEDICARE: GANESH CHIROPRACTIC, 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	4684	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	:	1861682676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANESH CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	2515 ALEXANDRIA PIKE
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-1317
Country	:	US
Telephone Number	:	859-781-1000
Fax Number	:	859-572-0244

Provider Business Practice Location Address
First Line	:	2515 ALEXANDRIA PIKE
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-1317
Country	:	US
Telephone Number	:	859-781-1000
Fax Number	:	859-572-0244

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	SANTOSH K GANESH
Credential	:	D.C.
Telephone Number	:	859-781-1000

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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