Provider Demographics
NPI:1841362118
Name:COMBS, SAMUEL T JR (DC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:T
Last Name:COMBS
Suffix:JR
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:PO BOX 874
Mailing Address - Street 2:507 US HWY 25 W S-1
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702
Mailing Address - Country:US
Mailing Address - Phone:606-528-5822
Mailing Address - Fax:606-528-6369
Practice Address - Street 1:507 US HWY 25W S-1
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40702
Practice Address - Country:US
Practice Address - Phone:606-528-5822
Practice Address - Fax:606-528-6369
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY262243815OtherTAX I D
KY000000112947OtherBC BS
KY85000065Medicaid
KYU78737Medicare UPIN