Provider Demographics
NPI:1831475367
Name:LAKE CUMBERLAND CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:LAKE CUMBERLAND CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CATRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-340-1784
Mailing Address - Street 1:470 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1532
Mailing Address - Country:US
Mailing Address - Phone:606-340-1784
Mailing Address - Fax:888-878-5670
Practice Address - Street 1:470 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1532
Practice Address - Country:US
Practice Address - Phone:606-340-1784
Practice Address - Fax:888-878-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty