Healthcare Provider Details

I. General information

NPI: 1548471659
Provider Name (Legal Business Name): AMBER BLANTON-MCCALVIN CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28350 U.S. 23
SOUTH SHORE KY
41175
US

IV. Provider business mailing address

PO BOX 22
SOUTH SHORE KY
41175-0022
US

V. Phone/Fax

Practice location:
  • Phone: 606-932-2414
  • Fax: 606-932-2421
Mailing address:
  • Phone: 606-932-2414
  • Fax: 606-932-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5021
License Number StateKY

VIII. Authorized Official

Name: DR. AMBER BETH BLANTON-MCCALVIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 606-932-2414