Provider Demographics
NPI:1124156252
Name:MENDEZ CHIROPRACTIC CENTRE PSC
Entity type:Organization
Organization Name:MENDEZ CHIROPRACTIC CENTRE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:TOMAS
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-273-4455
Mailing Address - Street 1:207 E REYNOLDS RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1276
Mailing Address - Country:US
Mailing Address - Phone:859-273-4455
Mailing Address - Fax:859-272-9134
Practice Address - Street 1:207 E REYNOLDS RD STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1276
Practice Address - Country:US
Practice Address - Phone:859-273-4455
Practice Address - Fax:859-272-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY06842Medicare UPIN
KY0987401Medicare ID - Type Unspecified