Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4129 | KY |
Y | 111NN1001X | Nutrition | 4129 | KY |
NPI | 1316967136 |
---|---|
Provider Name | Dr. Craig D Mackey |
First Address | Danville, KY 40423-0356 |
Second Address | Danville, KY 40422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000382972 | ANTHEM BC/BS (01) | KY |
85000164 | (05) | KY |
U48410 | (02) | KY |