Provider Demographics
NPI:1316905649
Name:SCHOONOVER, KENT LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:LEWIS
Last Name:SCHOONOVER
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 1:21 STATE ROUTE 3305 S
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-7915
Mailing Address - Country:US
Mailing Address - Phone:270-388-7707
Mailing Address - Fax:
Practice Address - Street 1:21 STATE ROUTE 3305 S
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038-7915
Practice Address - Country:US
Practice Address - Phone:270-388-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002285Medicaid
KYU88478Medicare UPIN
KY85002285Medicaid