Healthcare Provider Details

I. General information

NPI: 1356430185
Provider Name (Legal Business Name): WESTERN KENTUCKY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 E 4TH ST
RUSSELLVILLE KY
42276-1820
US

IV. Provider business mailing address

PO BOX 1287
BOWLING GREEN KY
42102-1287
US

V. Phone/Fax

Practice location:
  • Phone: 270-726-3164
  • Fax: 270-726-1520
Mailing address:
  • Phone: 270-726-3164
  • Fax: 270-726-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4494
License Number StateKY

VIII. Authorized Official

Name: DR. KEITH ALAN JONES
Title or Position: OWNER
Credential: D.C.
Phone: 270-726-3164