Provider Demographics
NPI:1508137639
Name:WHIDDEN, INC.
Entity Type:Organization
Organization Name:WHIDDEN, INC.
Other - Org Name:EMERALD COAST CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-654-1850
Mailing Address - Street 1:501 HARBOR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2348
Mailing Address - Country:US
Mailing Address - Phone:850-654-1850
Mailing Address - Fax:850-654-9994
Practice Address - Street 1:501 HARBOR BLVD STE C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2348
Practice Address - Country:US
Practice Address - Phone:850-654-1850
Practice Address - Fax:850-654-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty