Kandice Joette Wommack, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4556 Issued in KY

Practice address

142 Vine St
Benton, KY 42025-7472

Phone

(270) 527-0000

Fax

(270) 527-2121

NPI assigned

Jul 7, 2006

Last updated

Oct 16, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 1999

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dilatush Chiropractic, Inc.

  • Chiropractor
  • Benton, KY
  • NPI 1225315203
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508112000000",
    "number": "1467484980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 VINE ST",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420257472",
            "telephone_number": "270-527-0000",
            "fax_number": "270-527-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 VINE ST",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420257472",
            "telephone_number": "270-527-0000",
            "fax_number": "270-527-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOMMACK",
        "first_name": "KANDICE",
        "middle_name": "JOETTE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2017-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": "4556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "614099",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "44-00390",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7670104",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHRM BCBS",
            "identifier": "000000077520",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350052669",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Sowell Gibson OD
• West Kentucky Chiropractic and Performance Center (West Kentucky Chiropractic and Performance)
• Saundra H White, APRN
• Madison Brooke Wilkins, RBT
• James Blake Wiseman, PHARMD.

• Chiropractor in Benton, KY
• Providers in Benton, KY by specialty
• Chiropractor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.