Provider Demographics
NPI:1356364574
Name:CUNDIFF, KERRY DARIN (DC)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:DARIN
Last Name:CUNDIFF
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 1:323 S WALLACE WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539
Mailing Address - Country:US
Mailing Address - Phone:606-787-7900
Mailing Address - Fax:606-787-2225
Practice Address - Street 1:323 S WALLACE WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539
Practice Address - Country:US
Practice Address - Phone:606-787-7900
Practice Address - Fax:606-787-2225
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002111Medicaid
KY0993101Medicare ID - Type Unspecified
U90868Medicare UPIN