Provider Demographics
NPI:1154366490
Name:TAULBEE, KEITH ALLEN (DC)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:TAULBEE
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 1:75 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1886
Mailing Address - Country:US
Mailing Address - Phone:740-380-9355
Mailing Address - Fax:740-380-2273
Practice Address - Street 1:75 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1886
Practice Address - Country:US
Practice Address - Phone:740-380-9355
Practice Address - Fax:740-380-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026168Medicaid
OHTA0835181Medicare ID - Type Unspecified
OH2026168Medicaid