Provider Demographics
NPI:1992104558
Name:MG CHIROPRACTIC
Entity type:Organization
Organization Name:MG CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-961-0007
Mailing Address - Street 1:7702 PRESTON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3139
Mailing Address - Country:US
Mailing Address - Phone:502-961-0007
Mailing Address - Fax:502-961-0005
Practice Address - Street 1:7702 PRESTON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3139
Practice Address - Country:US
Practice Address - Phone:502-961-0007
Practice Address - Fax:502-961-0005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MG CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-20
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty