Provider Demographics
NPI:1245226992
Name:WADLE, KEVIN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:WADLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SETTLERS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-7732
Mailing Address - Country:US
Mailing Address - Phone:502-477-5000
Mailing Address - Fax:502-477-5005
Practice Address - Street 1:101 SETTLERS CENTER RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-7732
Practice Address - Country:US
Practice Address - Phone:502-477-5000
Practice Address - Fax:502-477-5005
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85043289Medicaid
KY1065686OtherPASSPORT
KY7555Medicare UPIN
KY85043289Medicaid
KY0755501Medicare UPIN