Provider Demographics
NPI:1629895958
Name:RACINE, CHENICA MARIA
Entity type:Individual
Prefix:
First Name:CHENICA
Middle Name:MARIA
Last Name:RACINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 GIRARD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6649
Mailing Address - Country:US
Mailing Address - Phone:502-443-4900
Mailing Address - Fax:
Practice Address - Street 1:1612 GIRARD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6649
Practice Address - Country:US
Practice Address - Phone:502-443-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management