Oldham County Spine & Rehab Center PSC
Organization Active NPI Chiropractor · Lagrange, KY
NPI 1689851602 · NPPES record last updated Jul 3, 2008
Key facts
- NPI
- 1689851602
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- OLDHAM COUNTY SPINE & REHAB CENTER PSC
- Practice address
- 301 S 1St St
Lagrange, KY 40031-1240 - Phone
- (502) 222-0000
- Fax
- (502) 222-3488
- NPI assigned
- Jan 22, 2008
- Organization subpart
- No
Authorized official
- Name
- Lido Lee Petrucci, DC
- Title
- Owner
- Phone
- (502) 222-0000
Practitioners 1
-
Lido L Petrucci, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080912000457 | KY | Part B Supplier - Clinic/Group Practice | 7012083116 |
Receives reassigned benefits from 1 practitioner Practice locations: La Grange, KY |
National Provider Directory
Locations
301 S First Ave
Lagrange, KY 40031
Phone (502) 222-0000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
301 S 1St St
Lagrange, KY 40031-1240
Mailing address
301 S 1St St
Lagrange, KY 40031-1240
Phone (502) 222-0000
Other names
- LaGrange Chiropractic & Rehab
Other providers in Lagrange, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.