Provider Demographics
NPI:1174569073
Name:GEARHART, KENDALL RAE (DC)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:RAE
Last Name:GEARHART
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 1:1035 MORELAND DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001
Mailing Address - Country:US
Mailing Address - Phone:859-448-0858
Mailing Address - Fax:859-448-0957
Practice Address - Street 1:1035 MORELAND DR. STE.1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001
Practice Address - Country:US
Practice Address - Phone:859-448-0858
Practice Address - Fax:859-448-0957
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001600Medicaid
OH0197979Medicaid
KY85001600Medicaid
OH5763580001Medicare NSC
KYK017730Medicare PIN