Healthcare Provider Details

I. General information

NPI: 1063424182
Provider Name (Legal Business Name): MARK KEVIN CAWLEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 DONALDSON HWY
ERLANGER KY
41018-1073
US

IV. Provider business mailing address

926 DONALDSON HWY
ERLANGER KY
41018-1073
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-2222
  • Fax: 859-525-0999
Mailing address:
  • Phone: 859-525-2222
  • Fax: 859-525-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3843
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: