Provider Demographics
NPI:1447478409
Name:LAGRANGE CHIROPRACTIC
Entity type:Organization
Organization Name:LAGRANGE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:SIDNEY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-243-3334
Mailing Address - Street 1:6003 PLEASANT COLONY CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8678
Mailing Address - Country:US
Mailing Address - Phone:502-243-3334
Mailing Address - Fax:502-243-9786
Practice Address - Street 1:6003 PLEASANT COLONY CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8678
Practice Address - Country:US
Practice Address - Phone:502-243-3334
Practice Address - Fax:502-243-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX NUMBER
KY0951201Medicare ID - Type Unspecified
KY=========OtherTAX NUMBER