Healthcare Provider Details

I. General information

NPI: 1780798330
Provider Name (Legal Business Name): E TOWN CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WESTPORT RD STE A
ELIZABETHTOWN KY
42701-4408
US

IV. Provider business mailing address

620 WESTPORT RD STE A
ELIZABETHTOWN KY
42701-4408
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-9844
  • Fax: 270-769-2205
Mailing address:
  • Phone: 270-769-9844
  • Fax: 270-769-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number4102
License Number StateKY

VIII. Authorized Official

Name: DR. DEAN WILLIAM TINDALL
Title or Position: PRESDENT MEMBER
Credential: DC, ND, DCP, DABCO
Phone: 270-769-9844