Provider Demographics
NPI:1083809719
Name:CUNDIFF CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CUNDIFF CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:CUNDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-792-1845
Mailing Address - Street 1:230 LEXINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-1175
Mailing Address - Country:US
Mailing Address - Phone:859-792-1845
Mailing Address - Fax:859-792-1846
Practice Address - Street 1:230 LEXINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-1175
Practice Address - Country:US
Practice Address - Phone:859-792-1845
Practice Address - Fax:859-792-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00371Medicare PIN