Provider Demographics
NPI:1699224576
Name:TILLMAN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:TILLMAN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-608-8473
Mailing Address - Street 1:1601 W EVERLY BROTHERS BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-2707
Mailing Address - Country:US
Mailing Address - Phone:270-608-8473
Mailing Address - Fax:
Practice Address - Street 1:1601 W EVERLY BROTHERS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-2707
Practice Address - Country:US
Practice Address - Phone:270-608-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty