Provider Demographics
NPI:1780815142
Name:A & E CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:A & E CHIROPRACTIC, PLLC
Other - Org Name:MT. VERNON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-256-1986
Mailing Address - Street 1:70 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2948
Mailing Address - Country:US
Mailing Address - Phone:606-256-1986
Mailing Address - Fax:606-256-1984
Practice Address - Street 1:70 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2948
Practice Address - Country:US
Practice Address - Phone:606-256-1986
Practice Address - Fax:606-256-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU91249Medicare UPIN