Provider Demographics
NPI:1295176915
Name:HELTON, COLBY JOSEPH (CAC)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:JOSEPH
Last Name:HELTON
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3007
Mailing Address - Country:US
Mailing Address - Phone:502-290-8788
Mailing Address - Fax:502-290-8788
Practice Address - Street 1:311 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3007
Practice Address - Country:US
Practice Address - Phone:502-290-8788
Practice Address - Fax:502-290-8788
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC073171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist