Provider Demographics
NPI:1427029339
Name:GOLDEN, KENNETH J (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:GOLDEN
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 1:6925 E 96TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3644
Mailing Address - Country:US
Mailing Address - Phone:317-594-0004
Mailing Address - Fax:317-594-0005
Practice Address - Street 1:6925 E 96TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3644
Practice Address - Country:US
Practice Address - Phone:317-594-0004
Practice Address - Fax:317-594-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002147A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252020AMedicare PIN
INV02919Medicare UPIN