Provider Demographics
NPI:1699047910
Name:EVERWELL CHIROPRACTIC
Entity type:Organization
Organization Name:EVERWELL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-640-6938
Mailing Address - Street 1:12305 WESTPORT RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2711
Mailing Address - Country:US
Mailing Address - Phone:502-640-6938
Mailing Address - Fax:
Practice Address - Street 1:12305 WESTPORT RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2711
Practice Address - Country:US
Practice Address - Phone:502-640-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty