Provider Demographics
NPI:1508044496
Name:EHN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:EHN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:EHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-292-0123
Mailing Address - Street 1:1853 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2637
Mailing Address - Country:US
Mailing Address - Phone:859-292-0123
Mailing Address - Fax:859-292-0131
Practice Address - Street 1:1853 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2637
Practice Address - Country:US
Practice Address - Phone:859-292-0123
Practice Address - Fax:859-292-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002129Medicaid
KY85002129Medicaid