Provider Demographics
NPI:1750953618
Name:TRIVETTE, KODY
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:
Last Name:TRIVETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N CAROL MALONE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1126
Mailing Address - Country:US
Mailing Address - Phone:606-618-9600
Mailing Address - Fax:606-393-0902
Practice Address - Street 1:710 N CAROL MALONE BLVD STE B
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1126
Practice Address - Country:US
Practice Address - Phone:606-618-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor