Provider Demographics
NPI:1376520718
Name:KOTKIN, MICHELLE HEIDI (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HEIDI
Last Name:KOTKIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:KOTKIN
Other - Last Name:CORNETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1809 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-7300
Mailing Address - Fax:540-667-0567
Practice Address - Street 1:1809 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-7300
Practice Address - Fax:540-667-0567
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0300055Medicaid
VA14521OtherOPTIMA
203058OtherANTHEM
WV0132119000Medicaid
505187OtherHEALTH LINK NCPPO
601858500OtherUS DEPT OF LABOR
505187OtherHEALTH LINK NCPPO
601858500OtherUS DEPT OF LABOR