Provider Demographics
NPI:1962699249
Name:STALLINGS CHIROPRACTIC CENTER LLP
Entity type:Organization
Organization Name:STALLINGS CHIROPRACTIC CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:G
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-685-5100
Mailing Address - Street 1:820 CHUCK GRAY CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7362
Mailing Address - Country:US
Mailing Address - Phone:270-685-5100
Mailing Address - Fax:270-683-3100
Practice Address - Street 1:820 CHUCK GRAY CT
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7362
Practice Address - Country:US
Practice Address - Phone:270-685-5100
Practice Address - Fax:270-683-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000495Medicaid
KY85000495Medicaid
KYT54461Medicare UPIN