Provider Demographics
NPI:1245269133
Name:MOUNTAIN CHIROPRACTIC HEALTH, PLLC
Entity type:Organization
Organization Name:MOUNTAIN CHIROPRACTIC HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-487-8585
Mailing Address - Street 1:850 MORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9475
Mailing Address - Country:US
Mailing Address - Phone:606-487-8585
Mailing Address - Fax:606-487-8686
Practice Address - Street 1:850 MORTON BLVD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9475
Practice Address - Country:US
Practice Address - Phone:606-487-8585
Practice Address - Fax:606-487-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7842Medicare ID - Type Unspecified