Provider Demographics
NPI:1902651268
Name:PROACTIVE SPINE CARE
Entity Type:Organization
Organization Name:PROACTIVE SPINE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODPASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-485-4090
Mailing Address - Street 1:2835 S HIGHWAY 27 STE 338
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3063
Mailing Address - Country:US
Mailing Address - Phone:606-485-4090
Mailing Address - Fax:606-485-4093
Practice Address - Street 1:2835 S HIGHWAY 27 STE 338
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3063
Practice Address - Country:US
Practice Address - Phone:606-485-4090
Practice Address - Fax:606-485-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty