MEDICARE: DR. KEN CHILLSON DC

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	4873	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000393348	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1528126208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN CHILLSON DC

Provider Business Mailing Address
First Line	:	6013 PRESTON HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1317
Country	:	US
Telephone Number	:	502-964-6909
Fax Number	:	502-671-8621

Provider Business Practice Location Address
First Line	:	6013 PRESTON HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1317
Country	:	US
Telephone Number	:	502-964-6909
Fax Number	:	502-671-8621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. KEN CHILLSON DC” Practice Location

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