Provider Demographics
NPI:1902160351
Name:STANDING STONES CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:STANDING STONES CHIROPRACTIC, PLLC
Other - Org Name:BACK TO LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:502-241-1122
Mailing Address - Street 1:4201 W HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9758
Mailing Address - Country:US
Mailing Address - Phone:502-241-1122
Mailing Address - Fax:502-214-4222
Practice Address - Street 1:4201 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9758
Practice Address - Country:US
Practice Address - Phone:502-241-1122
Practice Address - Fax:502-470-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100260810Medicaid