Provider Demographics
NPI:1801857164
Name:ESTES, JOSEPH KELLY JR (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KELLY
Last Name:ESTES
Suffix:JR
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 1:3217 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4245
Mailing Address - Country:US
Mailing Address - Phone:270-442-6352
Mailing Address - Fax:270-443-3324
Practice Address - Street 1:3217 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4245
Practice Address - Country:US
Practice Address - Phone:270-442-6352
Practice Address - Fax:270-443-3324
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051247OtherANTHEM PROVIDER NUMBER
KYU41094Medicare UPIN
GAP00105614Medicare PIN
KY6070901Medicare PIN