Basic Information
| Provider Information | |||||||||
| NPI: | 1790419604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE ACCIDENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 SOUTHERN MANOR RD | ||||||||
| Address2: | |||||||||
| City: | VANCEBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411797511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067960385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 881 W NORTH BEND RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452241340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132384483 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2022 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | CAUDILL | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 6067960385 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.