Provider Demographics
NPI:1942283643
Name:COLWELL, FELTY BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:FELTY
Middle Name:BLAKE
Last Name:COLWELL
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 1:815 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2670
Mailing Address - Country:US
Mailing Address - Phone:270-351-3736
Mailing Address - Fax:270-351-3739
Practice Address - Street 1:815 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2670
Practice Address - Country:US
Practice Address - Phone:270-351-3736
Practice Address - Fax:270-351-3739
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1158922OtherFEDERAL TAX ID
KY6053601Medicare ID - Type UnspecifiedMEDICARE ID NUMBER