Provider Demographics
NPI:1700261088
Name:HASKELL, PAUL ERIC (LMT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ERIC
Last Name:HASKELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 ROSE PETAL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 NORTHSIDE DR
Practice Address - Street 2:HEBRON CHIROPRACTIC - #UNIT C
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048
Practice Address - Country:US
Practice Address - Phone:859-372-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-4531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-4531OtherLMT