Provider Demographics
NPI:1962699769
Name:RHONDA UNDERWOOD DC PLLC
Entity type:Organization
Organization Name:RHONDA UNDERWOOD DC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-786-2225
Mailing Address - Street 1:321 S DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1248
Mailing Address - Country:US
Mailing Address - Phone:270-786-2225
Mailing Address - Fax:270-786-3690
Practice Address - Street 1:321 S DIXIE ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1248
Practice Address - Country:US
Practice Address - Phone:270-786-2225
Practice Address - Fax:270-786-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000305831OtherANTHEM
KYP00192658OtherMC RAILROAD
KY000000305831OtherANTHEM
KYU97865Medicare UPIN