Provider Demographics
NPI:1376663773
Name:EASTLAND CHIROPRACTIC PSC
Entity type:Organization
Organization Name:EASTLAND CHIROPRACTIC PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LUCI
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-255-3777
Mailing Address - Street 1:2305 WOODHILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1023
Mailing Address - Country:US
Mailing Address - Phone:859-255-3777
Mailing Address - Fax:859-255-3967
Practice Address - Street 1:2305 WOODHILL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1023
Practice Address - Country:US
Practice Address - Phone:859-255-3777
Practice Address - Fax:859-255-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000369118OtherANTHEM PROVIDER ID
KY85003457Medicaid
KYCHAOther1221614
KY0966703Medicare PIN
KY85003457Medicaid
KY0966701Medicare PIN