Healthcare Provider Details

I. General information

NPI: 1962699769
Provider Name (Legal Business Name): RHONDA UNDERWOOD DC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 S DIXIE ST
HORSE CAVE KY
42749-1248
US

IV. Provider business mailing address

321 S DIXIE ST
HORSE CAVE KY
42749-1248
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-2225
  • Fax: 270-786-3690
Mailing address:
  • Phone: 270-786-2225
  • Fax: 270-786-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4780
License Number StateKY

VIII. Authorized Official

Name: RHONDA LEIGH UNDERWOOD
Title or Position: OWNER
Credential: DC
Phone: 270-786-2225