Provider Demographics
NPI:1356430185
Name:WESTERN KENTUCKY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:WESTERN KENTUCKY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-726-3164
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1287
Mailing Address - Country:US
Mailing Address - Phone:270-726-3164
Mailing Address - Fax:270-726-1520
Practice Address - Street 1:178 E 4TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1820
Practice Address - Country:US
Practice Address - Phone:270-726-3164
Practice Address - Fax:270-726-1520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN KENTUCKY CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU74073Medicare UPIN