Provider Demographics
NPI:1831234434
Name:PELTON, BARRY LEON (DC)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:LEON
Last Name:PELTON
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 1:1132 WINCHESTER RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4042
Mailing Address - Country:US
Mailing Address - Phone:859-254-0059
Mailing Address - Fax:859-254-1033
Practice Address - Street 1:1132 WINCHESTER RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4042
Practice Address - Country:US
Practice Address - Phone:859-254-0059
Practice Address - Fax:859-254-1033
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY250149111N00000X
KY3973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000644Medicaid
KY85000644Medicaid
6056201Medicare ID - Type Unspecified