Provider Demographics
NPI:1508130774
Name:KITCHEN, BRYANT L (DC)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:L
Last Name:KITCHEN
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 1:1744 E MCANDREWS RD
Mailing Address - Street 2:STE D
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5576
Mailing Address - Country:US
Mailing Address - Phone:541-582-2323
Mailing Address - Fax:541-582-2419
Practice Address - Street 1:230 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9416
Practice Address - Country:US
Practice Address - Phone:541-582-2323
Practice Address - Fax:541-582-2419
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor