Provider Demographics
NPI:1104955103
Name:MOUNTAIN CHIROPRACTIC HEALTH, PLLC
Entity type:Organization
Organization Name:MOUNTAIN CHIROPRACTIC HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-487-8585
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0060
Mailing Address - Country:US
Mailing Address - Phone:606-487-8585
Mailing Address - Fax:606-487-8686
Practice Address - Street 1:850 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9475
Practice Address - Country:US
Practice Address - Phone:606-487-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty