Organization
BODY STRUCTURE CLINIC INC.
Active
Organization
BODY STRUCTURE CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN M. BALCIRAK (OWNER/PRESIDENT)
(859) 268-8190
Entity
Organization
Contact information
Practice address
2600 GRIBBIN DR, LEXINGTON, KY 40517-4498
(859) 268-8190
(859) 268-8923
Mailing address
2600 GRIBBIN DR, LEXINGTON, KY 40517-4498
(859) 268-8190
(859) 268-8923
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
100890
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061166
ANTHEM BCBS
KY
Enumeration date
05/19/2006
Last updated
04/13/2012
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