Provider Demographics
NPI:1225467913
Name:DOWNTOWN CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-843-2255
Mailing Address - Street 1:720 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2247
Mailing Address - Country:US
Mailing Address - Phone:270-843-2255
Mailing Address - Fax:270-782-2822
Practice Address - Street 1:720 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2247
Practice Address - Country:US
Practice Address - Phone:270-843-2255
Practice Address - Fax:270-782-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty