Provider Demographics
NPI:1316280688
Name:VALLEY STATION CHIROPRACTIC & REHAB,PLLC
Entity type:Organization
Organization Name:VALLEY STATION CHIROPRACTIC & REHAB,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-933-2005
Mailing Address - Street 1:10400 DIXIE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-5913
Mailing Address - Country:US
Mailing Address - Phone:502-933-2005
Mailing Address - Fax:502-933-2074
Practice Address - Street 1:10400 DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-5913
Practice Address - Country:US
Practice Address - Phone:502-933-2005
Practice Address - Fax:502-933-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8503666300Medicaid
KY7487Medicare PIN