Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3494 | KY |
NPI | 1003807348 |
---|---|
Provider Name | Ernest Randolph Allen JR. |
First Address | Cadiz, KY 42211-0671 |
Second Address | Cadiz, KY 42211-9225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85000453 | (05) | KY |