Provider Demographics
NPI:1194982785
Name:KENTUCKY CHIROPRACTIC CENTER INC.
Entity type:Organization
Organization Name:KENTUCKY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SQUICCIARINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-441-8181
Mailing Address - Street 1:4 HIDDEN VALLEY DR
Mailing Address - Street 2:STE F
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-7610
Mailing Address - Country:US
Mailing Address - Phone:859-441-8181
Mailing Address - Fax:859-441-0113
Practice Address - Street 1:4 HIDDEN VALLEY DR
Practice Address - Street 2:STE F
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-7610
Practice Address - Country:US
Practice Address - Phone:859-441-8181
Practice Address - Fax:859-441-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001063Medicaid
6060601Medicare PIN
T54492Medicare UPIN