Provider Demographics
NPI:1568668499
Name:AMERICAN CHIROPRACTIC WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:AMERICAN CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BARTELT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-769-2255
Mailing Address - Street 1:519 B NORTH MILES SUITE 103
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7945
Mailing Address - Country:US
Mailing Address - Phone:270-769-2255
Mailing Address - Fax:270-763-9773
Practice Address - Street 1:2902 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7102
Practice Address - Country:US
Practice Address - Phone:270-769-2255
Practice Address - Fax:270-763-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002889Medicaid
KY7804Medicare PIN
KYU86685Medicare UPIN