Provider Demographics
NPI:1992118871
Name:FAMILY CHIROPRACTIC CENTER OF MURRAY,PLLC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF MURRAY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WUEST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-759-1945
Mailing Address - Street 1:1313 JOHNSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-0004
Mailing Address - Country:US
Mailing Address - Phone:270-759-1945
Mailing Address - Fax:270-759-1517
Practice Address - Street 1:1313 JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-0004
Practice Address - Country:US
Practice Address - Phone:270-759-1945
Practice Address - Fax:270-759-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82994Medicare UPIN
6106401Medicare PIN