Provider Demographics
NPI:1760643175
Name:EDELEN, AMY LYNN (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:EDELEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-478-4019
Mailing Address - Fax:270-478-4129
Practice Address - Street 1:2200 E PARRISH AVE BLDG C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-478-4019
Practice Address - Fax:270-478-4129
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100058410Medicaid
KY7100058410Medicaid