Provider Demographics
NPI:1407996838
Name:MOREHEAD, KENNETH FIELDING (MSOM, DOM (NM), LAC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:FIELDING
Last Name:MOREHEAD
Suffix:
Gender:M
Credentials:MSOM, DOM (NM), LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4141
Mailing Address - Country:US
Mailing Address - Phone:919-286-9595
Mailing Address - Fax:919-286-2425
Practice Address - Street 1:907 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4141
Practice Address - Country:US
Practice Address - Phone:919-286-9595
Practice Address - Fax:919-286-2425
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist