Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4102 | KY |
NPI | 1396762001 |
---|---|
Provider Name | Dr. Dean William Tindall |
First Address | Elizabethtown, KY 42701-4408 |
Second Address | Elizabethtown, KY 42701-4408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000051394 | ANTHEM/BCBS (01) | KY |
U60793 | (02) | KY |