MEDICARE: RUSSELLVILLE CHIROPRACTIC, L.L.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	4373	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952585408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELLVILLE CHIROPRACTIC, L.L.C.

Provider Business Mailing Address
First Line	:	909 WEST NINTH STREET
Second Line	:	SUITE A
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-9764
Country	:	US
Telephone Number	:	270-726-4600
Fax Number	:	270-726-4604

Provider Business Practice Location Address
First Line	:	909 WEST NINTH STREET
Second Line	:	SUITE A
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-9764
Country	:	US
Telephone Number	:	270-726-4600
Fax Number	:	270-726-4604

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID ALAN POE
Credential	:	D.C.
Telephone Number	:	270-726-4600

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	03/30/2020

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Directions to “RUSSELLVILLE CHIROPRACTIC, L.L.C. ” Practice Location

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