Provider Demographics
NPI:1346290541
Name:DICKHAUT, KEVIN JUHNO (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JUHNO
Last Name:DICKHAUT
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:PO BOX 99205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40269-0205
Mailing Address - Country:US
Mailing Address - Phone:502-409-6965
Mailing Address - Fax:502-384-8362
Practice Address - Street 1:4110 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1653
Practice Address - Country:US
Practice Address - Phone:502-409-6965
Practice Address - Fax:502-384-8362
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0486332Medicaid