Provider Demographics
NPI:1063424182
Name:CAWLEY, MARK KEVIN (DC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:KEVIN
Last Name:CAWLEY
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 1:926 DONALDSON HWY
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1073
Mailing Address - Country:US
Mailing Address - Phone:859-525-2222
Mailing Address - Fax:859-525-0999
Practice Address - Street 1:926 DONALDSON HWY
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1073
Practice Address - Country:US
Practice Address - Phone:859-525-2222
Practice Address - Fax:859-525-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000053867OtherANTHEM PIN
KY85000131Medicaid
KY85000131Medicaid
KY6075901Medicare ID - Type Unspecified