Provider Demographics
NPI:1053542134
Name:SOUTHSIDE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTHSIDE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAHRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-442-2211
Mailing Address - Street 1:3333 IRVIN COBB DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-0526
Mailing Address - Country:US
Mailing Address - Phone:270-442-2211
Mailing Address - Fax:270-933-1054
Practice Address - Street 1:3333 IRVIN COBB DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0526
Practice Address - Country:US
Practice Address - Phone:270-442-2211
Practice Address - Fax:270-933-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00554Medicare UPIN
01123Medicare PIN