Provider Demographics
NPI:1396815668
Name:KITCHEN, CHARLES EDWARD JR (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:KITCHEN
Suffix:JR
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 1:190 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2620
Mailing Address - Country:US
Mailing Address - Phone:740-775-9995
Mailing Address - Fax:740-775-9997
Practice Address - Street 1:190 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2620
Practice Address - Country:US
Practice Address - Phone:740-775-9995
Practice Address - Fax:740-775-9997
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2310111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000346129OtherANTHEM
OH2187146Medicaid
OHU61321Medicare UPIN
OH2187146Medicaid