Healthcare Provider Details

I. General information

NPI: 1821123811
Provider Name (Legal Business Name): ELDRIDGE-KEELIN CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WOLOHAN DR
ASHLAND KY
41102-8940
US

IV. Provider business mailing address

1320 WOLOHAN DR
ASHLAND KY
41102-8940
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-3364
  • Fax: 606-928-1531
Mailing address:
  • Phone: 606-928-3364
  • Fax: 606-928-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4794
License Number StateKY

VIII. Authorized Official

Name: ALICIA ELDRIDGE-KEELIN
Title or Position: OWNER
Credential: DC
Phone: 60692833364