Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2310 | OH |
NPI | 1396815668 |
---|---|
Provider Name | Charles Edward Kitchen JR. |
First Address | Chillicothe, OH 45601-2620 |
Second Address | Chillicothe, OH 45601-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000346129 | ANTHEM (01) | OH |
2187146 | (05) | OH |
U61321 | (02) | OH |