Provider Demographics
NPI:1427296250
Name:BACK, BODY & BEYOND CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BACK, BODY & BEYOND CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ABRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-618-3745
Mailing Address - Street 1:PO BOX 6544
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-0544
Mailing Address - Country:US
Mailing Address - Phone:502-618-3745
Mailing Address - Fax:502-618-3746
Practice Address - Street 1:2132 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2008
Practice Address - Country:US
Practice Address - Phone:502-618-3745
Practice Address - Fax:502-618-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5113111N00000X
KY111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100097680Medicaid