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General NPI Number Information
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NPI Number | 1831475367
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 470 N MAIN ST
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City | MONTICELLO
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State | KY
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Zip | 42633-1532
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Country | US
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Telephone | 606-340-1784
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Fax | 888-878-5670
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Provider Business Mailing Address
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Address Line | 470 N MAIN ST
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City | MONTICELLO
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State | KY
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Zip | 42633-1532
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Country | US
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Telephone | 606-340-1784
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Fax | 888-878-5670
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | KENDRA CATRON
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Credential | DC
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Telephone | 606-340-1784
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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 | 5306
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License Number State | KY
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