Provider Demographics
NPI:1407319452
Name:BENTLEY, COLTON KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:COLTON
Middle Name:KEITH
Last Name:BENTLEY
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 1:50 VILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3266
Mailing Address - Country:US
Mailing Address - Phone:606-432-0386
Mailing Address - Fax:606-432-1201
Practice Address - Street 1:50 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3266
Practice Address - Country:US
Practice Address - Phone:606-432-0386
Practice Address - Fax:606-432-1201
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor