Provider Demographics
NPI:1861520298
Name:MICHAEL GRASS
Entity type:Organization
Organization Name:MICHAEL GRASS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-3442
Mailing Address - Street 1:10400 DIXIE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3954
Mailing Address - Country:US
Mailing Address - Phone:502-933-2005
Mailing Address - Fax:502-933-2074
Practice Address - Street 1:10400 DIXIE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3954
Practice Address - Country:US
Practice Address - Phone:502-933-2005
Practice Address - Fax:502-933-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2441187000OtherPASSPORT ADVANTAGE
KY1076868OtherPASSPORT
KY8503666300Medicaid
KY000000050878OtherANTHEM BCBS PROVIDER PIN
KY2441187000OtherPASSPORT ADVANTAGE
KY1076868OtherPASSPORT
KYU52356Medicare UPIN