Provider Demographics
NPI:1972748218
Name:JEFFERSONTOWN CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:JEFFERSONTOWN CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-214-2360
Mailing Address - Street 1:10131 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3649
Mailing Address - Country:US
Mailing Address - Phone:502-267-6444
Mailing Address - Fax:502-267-6445
Practice Address - Street 1:10131 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-3649
Practice Address - Country:US
Practice Address - Phone:502-267-6444
Practice Address - Fax:502-267-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9271191OtherAETNA
KY50020127Medicaid
KY10654338786OtherHUMANA
KY3141631OtherCIGNA
KY586259OtherANTHEM
KY10654338786OtherHUMANA