Provider Demographics
NPI:1396762001
Name:TINDALL, DEAN WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:WILLIAM
Last Name:TINDALL
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 1:620 WESTPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4408
Mailing Address - Country:US
Mailing Address - Phone:270-769-9844
Mailing Address - Fax:270-769-2205
Practice Address - Street 1:620 WESTPORT RD STE A
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4408
Practice Address - Country:US
Practice Address - Phone:270-769-9844
Practice Address - Fax:270-769-2205
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4102111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051394OtherANTHEM/BCBS
KYU60793Medicare UPIN
KY6073301Medicare ID - Type UnspecifiedMEDICARE #