Provider Demographics
NPI:1649301284
Name:POE, DAVID ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:POE
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 1:909 W 9TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9764
Mailing Address - Country:US
Mailing Address - Phone:270-726-4600
Mailing Address - Fax:
Practice Address - Street 1:909 W 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9764
Practice Address - Country:US
Practice Address - Phone:270-726-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85043735Medicaid