| Rettay Chiropractic Office Psc | |
|
7560 B Burlington Pike Florence KY 41042-9634 | |
| (859) 525-7117 | |
| (859) 282-3343 |
| Full Name | Rettay Chiropractic Office Psc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7560 B Burlington Pike, Florence, Kentucky |
| Authorized Official Name and Position | Lawrence Mikkelson (CHIROPRACTOR) |
| Authorized Official Contact | 8595257117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rettay Chiropractic Office Psc Po Box 547 7560 B Burlington Pike Florence KY 41042-9634 Ph: (859) 525-7117 | Rettay Chiropractic Office Psc 7560 B Burlington Pike Florence KY 41042-9634 Ph: (859) 525-7117 |
| NPI Number | 1235314071 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 12/11/2009 |
| Medicare PECOS PAC ID | 5092747436 |
|---|---|
| Medicare Enrollment ID | O20091211000681 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235314071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 4396 (Kentucky) | Primary |
| Provider Name | Lawrence R Mikkelson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1134125768 PECOS PAC ID: 7214077841 Enrollment ID: I20091211000673 |
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