Provider Demographics
NPI:1861601528
Name:DOLWIG, DAVID THOMAS (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:DOLWIG
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 1:907 N. MULBERRY ST.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2033
Mailing Address - Country:US
Mailing Address - Phone:270-505-1087
Mailing Address - Fax:270-505-1239
Practice Address - Street 1:907 N. MULBERRY ST.
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2033
Practice Address - Country:US
Practice Address - Phone:270-505-1087
Practice Address - Fax:270-505-1239
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5856111N00000X
CA29940111N00000X
KY5091111N00000X
IL038011001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100042060Medicaid
KY6040208Medicare PIN