Provider Demographics
NPI:1548802291
Name:CORNETT, DILLON MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:MICHAEL
Last Name:CORNETT
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 1:100 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9483
Mailing Address - Country:US
Mailing Address - Phone:606-439-3399
Mailing Address - Fax:606-487-9280
Practice Address - Street 1:100 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9483
Practice Address - Country:US
Practice Address - Phone:606-439-3399
Practice Address - Fax:606-487-9280
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor