Provider Demographics
NPI:1134232127
Name:PELHAM, ROBERT F (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:PELHAM
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 1:205 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2931
Mailing Address - Country:US
Mailing Address - Phone:270-651-8340
Mailing Address - Fax:270-651-6479
Practice Address - Street 1:205 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2931
Practice Address - Country:US
Practice Address - Phone:270-651-8340
Practice Address - Fax:270-651-6479
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85035087Medicaid
KYT54215Medicare UPIN
KY85035087Medicaid
KY6105001Medicare ID - Type Unspecified