Provider Demographics
NPI:1073610143
Name:VINCENT, BETTY MELANIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:MELANIE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431
Mailing Address - Country:US
Mailing Address - Phone:270-825-4333
Mailing Address - Fax:270-825-4333
Practice Address - Street 1:329 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-825-4333
Practice Address - Fax:270-825-4333
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000208785OtherBLUE CROSS BLUE SHIELD
U88950Medicare UPIN
KY000000208785OtherBLUE CROSS BLUE SHIELD