Provider Demographics
NPI:1982746913
Name:BLUEGRASS FAMILY CHIROPRACTIC, PSC
Entity type:Organization
Organization Name:BLUEGRASS FAMILY CHIROPRACTIC, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-251-0907
Mailing Address - Street 1:1011 PARIS ROAD
Mailing Address - Street 2:#341
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-251-0907
Mailing Address - Fax:270-251-0908
Practice Address - Street 1:1011 PARIS ROAD
Practice Address - Street 2:#341
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-251-0907
Practice Address - Fax:270-251-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000289323OtherANTHEM PIN
KY85002699Medicaid
KY0754101Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
KY000000289323OtherANTHEM PIN
KY6390260001Medicare NSC