Organization
BODY STRUCTURE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL SIDWELL (OFFICE MANGER)
(859) 268-8190
Entity
Organization
Contact information
Practice address
2600 GRIBBIN DR., LEXINGTON, KY 40517
(859) 268-8190
Mailing address
2600 GRIBBIN DR., LEXINGTON, KY 40517
(859) 268-8190
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164848
KY
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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