Provider Demographics
NPI:1508950452
Name:KOTKIN CHIROPRACTIC CENTER PLC
Entity Type:Organization
Organization Name:KOTKIN CHIROPRACTIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-667-7300
Mailing Address - Street 1:1809 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22607
Mailing Address - Country:US
Mailing Address - Phone:540-667-7300
Mailing Address - Fax:540-667-0567
Practice Address - Street 1:1809 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-7300
Practice Address - Fax:540-667-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132119000Medicaid
14521OtherOPTIMA
VA0300055Medicaid
505187OtherHEALTHLINK NCPPO
VA203058OtherBLUE CROSS
U59552Medicare UPIN