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General NPI Number Information
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NPI Number | 1780815142
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Entity Type | Organization
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Legal Business Name | A & E CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 70 SCHOOL ST
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City | MOUNT VERNON
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State | KY
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Zip | 40456-2948
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Country | US
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Telephone | 606-256-1986
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Fax | 606-256-1984
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Provider Business Mailing Address
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Address Line | 70 SCHOOL ST
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City | MOUNT VERNON
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State | KY
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Zip | 40456-2948
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Country | US
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Telephone | 606-256-1986
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Fax | 606-256-1984
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW BRIAN TACKETT
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Credential | D.C.
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Telephone | 606-256-1986
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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 | 4673
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License Number State | KY
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