Provider Demographics
NPI:1659553873
Name:RUSSELLVILLE CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:RUSSELLVILLE CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-726-4600
Mailing Address - Street 1:487 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1324
Mailing Address - Country:US
Mailing Address - Phone:270-726-4600
Mailing Address - Fax:270-726-4604
Practice Address - Street 1:487 W 4TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1324
Practice Address - Country:US
Practice Address - Phone:270-726-4600
Practice Address - Fax:270-726-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85043735Medicaid
KY1681801Medicare PIN
KY85043735Medicaid