MEDICARE: MEM OF KENTUCKY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4933	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00406875	OTHER	KY	RRMEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000364523	OTHER	KY	BC/BS
2	7036717	OTHER	KY	AETNA
3	708614	OTHER	KY	HEALTHLINK
4	1223580	OTHER	KY	CHA
5	670409	OTHER	KY	ACN
6	670409117532	OTHER	KY	UHC

General Provider Information

NPI Number	:	1033358130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEM OF KENTUCKY, INC.

Provider Business Mailing Address
First Line	:	7030 US HIGHWAY 68
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-9108
Country	:	US
Telephone Number	:	270-898-2111
Fax Number	:	270-898-2112

Provider Business Practice Location Address
First Line	:	7030 US HIGHWAY 68
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-9108
Country	:	US
Telephone Number	:	270-898-2111
Fax Number	:	270-898-2112

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WESLEY D MOREFIELD
Credential	:	D.C.
Telephone Number	:	270-898-2111

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	05/05/2009

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Directions to “MEM OF KENTUCKY, INC. ” Practice Location

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