Provider Demographics
NPI:1396068268
Name:BASIC HEALTH CHIROPRACTIC AND REHAB
Entity type:Organization
Organization Name:BASIC HEALTH CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:UHLMANSIEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-525-1695
Mailing Address - Street 1:5915 MERCHANTS STREET
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41024
Mailing Address - Country:US
Mailing Address - Phone:859-525-1695
Mailing Address - Fax:859-525-0169
Practice Address - Street 1:5915 MERCHANTS STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41024
Practice Address - Country:US
Practice Address - Phone:859-525-1695
Practice Address - Fax:859-525-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty