Provider Demographics
NPI:1134314230
Name:CUNDIFF FAMILY CHIROPRACTIC, PSC
Entity Type:Organization
Organization Name:CUNDIFF FAMILY CHIROPRACTIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:K. DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-787-7900
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-1450
Mailing Address - Country:US
Mailing Address - Phone:606-787-7900
Mailing Address - Fax:606-787-2225
Practice Address - Street 1:256 N. WALLACE WILKINSON BLVD.
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-7900
Practice Address - Fax:606-787-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002111Medicaid
KYU90868Medicare UPIN
KY9931Medicare PIN