Provider Demographics
NPI:1407137912
Name:WHITT, MATTHEW KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KENNETH
Last Name:WHITT
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 1:650 MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-1018
Mailing Address - Country:US
Mailing Address - Phone:606-743-3889
Mailing Address - Fax:606-743-9536
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1018
Practice Address - Country:US
Practice Address - Phone:606-743-3889
Practice Address - Fax:606-743-9536
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor