Provider Demographics
NPI:1730231309
Name:AMERICAN CHIROPRACTIC-DOWNTOWN
Entity type:Organization
Organization Name:AMERICAN CHIROPRACTIC-DOWNTOWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-681-6800
Mailing Address - Street 1:418 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1706
Mailing Address - Country:US
Mailing Address - Phone:502-681-6800
Mailing Address - Fax:502-681-6868
Practice Address - Street 1:418 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1706
Practice Address - Country:US
Practice Address - Phone:502-681-6800
Practice Address - Fax:502-681-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7643Medicare ID - Type Unspecified