Provider Demographics
NPI:1386807634
Name:OAKLEY CHIROPRACTIC CENTER PSC
Entity type:Organization
Organization Name:OAKLEY CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-864-1444
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1627
Mailing Address - Country:US
Mailing Address - Phone:606-864-1444
Mailing Address - Fax:606-864-1269
Practice Address - Street 1:212 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7238
Practice Address - Country:US
Practice Address - Phone:606-864-1444
Practice Address - Fax:606-864-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003929Medicaid
KY0981201Medicare PIN