Provider Demographics
NPI:1013908722
Name:FAULKNER, MARVIN CHAD (DC)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:CHAD
Last Name:FAULKNER
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 1:113 MALONEY WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9553
Mailing Address - Country:US
Mailing Address - Phone:859-762-0009
Mailing Address - Fax:859-305-1639
Practice Address - Street 1:113 MALONEY WAY
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9553
Practice Address - Country:US
Practice Address - Phone:859-762-0009
Practice Address - Fax:859-305-1639
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY249710111N00000X
AZ8287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK194510Medicare PIN
AZZ155759Medicare UPIN