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General NPI Number Information
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NPI Number | 1952585408
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE CHIROPRACTIC, L.L.C.
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 909 WEST NINTH STREET SUITE A
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-9764
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Country | US
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Telephone | 270-726-4600
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Fax | 270-726-4604
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Provider Business Mailing Address
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Address Line | 909 WEST NINTH STREET SUITE A
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City | RUSSELLVILLE
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State | KY
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Zip | 42276-9764
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Country | US
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Telephone | 270-726-4600
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Fax | 270-726-4604
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID ALAN POE
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Credential | D.C.
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Telephone | 270-726-4600
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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 | 4373
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License Number State | KY
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