Provider Demographics
NPI:1316044654
Name:ABERNATHY, KIRK A (DC)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:A
Last Name:ABERNATHY
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 1:139 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:IA
Mailing Address - Zip Code:52142-0578
Mailing Address - Country:US
Mailing Address - Phone:563-425-3341
Mailing Address - Fax:563-425-3342
Practice Address - Street 1:139 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-0578
Practice Address - Country:US
Practice Address - Phone:563-425-3341
Practice Address - Fax:563-425-3342
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
IAA5607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0104646Medicaid
U43741Medicare UPIN
IA0104646Medicaid