Provider Demographics
NPI:1164474169
Name:KIDWELL, ASHLEY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:THOMAS
Last Name:KIDWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:KS
Mailing Address - Zip Code:66439-0106
Mailing Address - Country:US
Mailing Address - Phone:913-575-0763
Mailing Address - Fax:
Practice Address - Street 1:106 W 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:KS
Practice Address - Zip Code:66439-1666
Practice Address - Country:US
Practice Address - Phone:913-575-0763
Practice Address - Fax:785-264-4702
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012878111N00000X
KS01-04904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660153OtherMEDICARE GROUP PROVIDER #
KS062327OtherMEDICARE INDIVIDUAL #
KS062327OtherBLUE CROSS BLUE SHIELD INDIVIDUAL #
KS660153OtherBLUE CROSS BLUE SHIELD GROUP #
KS062327OtherMEDICARE INDIVIDUAL #