Provider Demographics
NPI:1821123811
Name:ELDRIDGE-KEELIN CHIROPRACTIC
Entity Type:Organization
Organization Name:ELDRIDGE-KEELIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE-KEELIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:6069-283-3364
Mailing Address - Street 1:1320 WOLOHAN DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-8940
Mailing Address - Country:US
Mailing Address - Phone:606-928-3364
Mailing Address - Fax:606-928-1531
Practice Address - Street 1:1320 WOLOHAN DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8940
Practice Address - Country:US
Practice Address - Phone:606-928-3364
Practice Address - Fax:606-928-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8916Medicare PIN