Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH13295 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | 8381395-1202 | UT |
NPI | 1366796351 |
---|---|
Provider Name | Dr. Kenneth Andrew Boothe |
First Address | Clearwater, FL 33764-3104 |
Second Address | Clearwater, FL 33764-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 22/12/2021 |