Provider Demographics
NPI:1962917682
Name:BOWLING GREEN FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BOWLING GREEN FAMILY CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-408-5440
Mailing Address - Street 1:651 US 31W BYP STE 202
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4977
Mailing Address - Country:US
Mailing Address - Phone:270-904-1837
Mailing Address - Fax:270-904-6394
Practice Address - Street 1:651 US 31W BYP STE 202
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4977
Practice Address - Country:US
Practice Address - Phone:270-904-1837
Practice Address - Fax:270-904-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100583510Medicaid