Provider Demographics
NPI:1487781852
Name:THAUBERGER CHIROPRACTIC PSC.
Entity type:Organization
Organization Name:THAUBERGER CHIROPRACTIC PSC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:THAUBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-969-7246
Mailing Address - Street 1:11311 WOODED BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3599
Mailing Address - Country:US
Mailing Address - Phone:502-969-7246
Mailing Address - Fax:502-961-0392
Practice Address - Street 1:8511 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-5301
Practice Address - Country:US
Practice Address - Phone:502-969-7246
Practice Address - Fax:502-961-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9838Medicare ID - Type Unspecified