Provider Demographics
NPI:1205990769
Name:STUKEY, MITCHEL KENT (DC)
Entity type:Individual
Prefix:
First Name:MITCHEL
Middle Name:KENT
Last Name:STUKEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FREDERICA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6981
Mailing Address - Country:US
Mailing Address - Phone:270-926-1774
Mailing Address - Fax:
Practice Address - Street 1:3600 FREDERICA ST
Practice Address - Street 2:SUITE A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6981
Practice Address - Country:US
Practice Address - Phone:270-926-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor