Provider Demographics
NPI:1659714723
Name:PELPHREY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PELPHREY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PELPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-296-4889
Mailing Address - Street 1:616 WELLINGTON WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2734
Mailing Address - Country:US
Mailing Address - Phone:859-296-4889
Mailing Address - Fax:859-296-1628
Practice Address - Street 1:616 WELLINGTON WAY
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2734
Practice Address - Country:US
Practice Address - Phone:859-296-4889
Practice Address - Fax:859-296-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5373OtherSTATE LICENSE NUMBER
KY1487990610OtherPERSONAL NPI