Provider Demographics
NPI:1861412199
Name:CUNNINGHAM, CHANDRA L (DC)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:L
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10306 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2914
Mailing Address - Country:US
Mailing Address - Phone:502-245-7334
Mailing Address - Fax:502-245-7187
Practice Address - Street 1:10306 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2914
Practice Address - Country:US
Practice Address - Phone:502-245-7334
Practice Address - Fax:502-245-7187
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008004111N00000X
KY5213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV04288Medicare UPIN
GAGRP1678Medicare ID - Type UnspecifiedGROUP NUMBER