Provider Demographics
NPI:1174094619
Name:KENT CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:KENT CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:334-297-2225
Mailing Address - Street 1:1602 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3714
Mailing Address - Country:US
Mailing Address - Phone:334-297-2225
Mailing Address - Fax:334-480-9758
Practice Address - Street 1:1602 20TH AVE
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3714
Practice Address - Country:US
Practice Address - Phone:334-297-2225
Practice Address - Fax:334-480-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty