Provider Demographics
NPI:1699736694
Name:SHORT, CALLIE (DC)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1846
Mailing Address - Country:US
Mailing Address - Phone:859-239-0022
Mailing Address - Fax:859-239-0044
Practice Address - Street 1:434 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-239-0022
Practice Address - Fax:859-239-0044
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY620702OtherACN
KY85001923Medicaid
KY000000213281OtherANTHEM
KY000000213281OtherANTHEM
KY85001923Medicaid