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General NPI Number Information
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NPI Number | 1356430185
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Entity Type | Organization
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Legal Business Name | WESTERN KENTUCKY CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 178 E 4TH ST
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-1820
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Country | US
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Telephone | 270-726-3164
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Fax | 270-726-1520
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Provider Business Mailing Address
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Address Line | PO BOX 1287
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City | BOWLING GREEN
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State | KY
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Zip | 42102-1287
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Country | US
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Telephone | 270-726-3164
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Fax | 270-726-1520
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH ALAN JONES
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Credential | D.C.
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Telephone | 270-726-3164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4494
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License Number State | KY
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