Healthcare Provider Details

I. General information

NPI: 1811905862
Provider Name (Legal Business Name): DAVID STEWART CHALKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ADAMS ST
PADUCAH KY
42003-1537
US

IV. Provider business mailing address

412 ADAMS ST
PADUCAH KY
42003-1537
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-3988
  • Fax: 270-442-4645
Mailing address:
  • Phone: 270-442-3988
  • Fax: 270-442-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4678
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: