Healthcare Provider Details

I. General information

NPI: 1306929047
Provider Name (Legal Business Name): TIMOTHY D EHN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 US 42 SUITE A
FLORENCE KY
41042-6936
US

IV. Provider business mailing address

8780 US 42 SUITE A
FLORENCE KY
41042-6936
US

V. Phone/Fax

Practice location:
  • Phone: 859-292-0123
  • Fax: 859-292-0131
Mailing address:
  • Phone: 859-292-0123
  • Fax: 859-292-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4647
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002590A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: