Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4684 | KY |
N | 111NR0400X | Rehabilitation Chiropractor | 4684 | KY |
NPI | 1265519870 |
---|---|
Provider Name | Dr. Santosh K Ganesh |
First Address | Cold Spring, KY 41076-2026 |
Second Address | Cold Spring, KY 41076-2026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85002012 | (05) | KY |