Provider Demographics
NPI:1306258488
Name:BACK TALK CHIROPRACTIC PSC
Entity type:Organization
Organization Name:BACK TALK CHIROPRACTIC PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACBSP
Authorized Official - Phone:859-309-0377
Mailing Address - Street 1:1300 E NEW CIRCLE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4256
Mailing Address - Country:US
Mailing Address - Phone:859-309-0377
Mailing Address - Fax:859-309-0381
Practice Address - Street 1:1300 E NEW CIRCLE RD STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4256
Practice Address - Country:US
Practice Address - Phone:859-309-0377
Practice Address - Fax:859-309-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000722788OtherANTHEM
KYK015320OtherMEDICARE
KY1136817OtherAMERICAN SPECIALTY HEALTH
KY664895OtherWELLCARE OF KENTUCKY
KY7100186170Medicaid