MEDICARE: DR. RICHARD DALE VALLOTTON D.C.

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	5011	KY

General Provider Information

NPI Number	:	1740399914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD DALE VALLOTTON D.C.

Provider Business Mailing Address
First Line	:	117 RUFFIAN TRL
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-8447
Country	:	US
Telephone Number	:	502-644-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EASTSIDE DR
Second Line	:
City	:	GEORGETOWN
State	:	KY
Zip	:	40324-9797
Country	:	US
Telephone Number	:	502-868-0097
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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