Provider Demographics
NPI:1487964318
Name:ALL EASE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ALL EASE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-526-6206
Mailing Address - Street 1:1116 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-9409
Mailing Address - Country:US
Mailing Address - Phone:270-526-6206
Mailing Address - Fax:270-526-6296
Practice Address - Street 1:1116 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9409
Practice Address - Country:US
Practice Address - Phone:270-526-6206
Practice Address - Fax:270-526-6296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100148660Medicaid
KYP400027901Medicare UPIN
KY7100148660Medicaid