Provider Demographics
NPI:1598850380
Name:MARMON, TERRY KEVYN II (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:KEVYN
Last Name:MARMON
Suffix:II
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 1:606-A BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-350-3700
Mailing Address - Fax:502-350-3701
Practice Address - Street 1:606-A BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-350-3700
Practice Address - Fax:502-350-3701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001931Medicaid
KY1155747OtherPASSPORT
U66567Medicare UPIN
KY1155747OtherPASSPORT