Provider Demographics
NPI:1730416033
Name:IROQUOIS CHIROPRACTIC
Entity type:Organization
Organization Name:IROQUOIS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTECALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-377-3044
Mailing Address - Street 1:5330 S 3RD ST STE 222
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2687
Mailing Address - Country:US
Mailing Address - Phone:502-377-3044
Mailing Address - Fax:888-568-4625
Practice Address - Street 1:5330 S 3RD ST STE 222
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2687
Practice Address - Country:US
Practice Address - Phone:502-377-3044
Practice Address - Fax:888-568-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty