Provider Demographics
NPI:1699980383
Name:CAMPBELLSBURG CHIROPRACTIC, PSC
Entity type:Organization
Organization Name:CAMPBELLSBURG CHIROPRACTIC, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-532-0099
Mailing Address - Street 1:8172 MAIN ST
Mailing Address - Street 2:PO BOX 293
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40011-0293
Mailing Address - Country:US
Mailing Address - Phone:502-532-0099
Mailing Address - Fax:502-532-0096
Practice Address - Street 1:8172 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSBURG
Practice Address - State:KY
Practice Address - Zip Code:40011-0293
Practice Address - Country:US
Practice Address - Phone:502-532-0099
Practice Address - Fax:502-532-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4721111N00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8500359800Medicaid
KY8500359800Medicaid
8919Medicare PIN