Provider Demographics
NPI:1225038839
Name:MCCRACKEN COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:MCCRACKEN COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:ATNIP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-444-7111
Mailing Address - Street 1:3305 MAXON RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9650
Mailing Address - Country:US
Mailing Address - Phone:270-442-0333
Mailing Address - Fax:270-444-7122
Practice Address - Street 1:2731 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3855
Practice Address - Country:US
Practice Address - Phone:270-444-7111
Practice Address - Fax:270-444-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4624111N00000X
KY4857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000318314OtherANTHEM M ATNIP
KY85001402Medicaid
KY85900371Medicaid
KY000000338910OtherANTHEM T KAHRE
KY85003093Medicaid
KY=========OtherTAX ID
KYP00181676Medicare PIN
KYDB0778Medicare ID - Type UnspecifiedRR MEDICARE GROUP
KY85003093Medicaid
KY=========OtherTAX ID
KYP00085622Medicare PIN