Provider Demographics
NPI:1790867463
Name:KIRBY, ROBERT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:KIRBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 N BROADWAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-3157
Mailing Address - Country:US
Mailing Address - Phone:859-543-0252
Mailing Address - Fax:859-543-0698
Practice Address - Street 1:1412 N BROADWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3157
Practice Address - Country:US
Practice Address - Phone:859-543-0252
Practice Address - Fax:859-543-0698
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890085M4Medicaid
NC085M4OtherBCBS
NC890085M4Medicaid
NCU90390Medicare UPIN