Provider Demographics
NPI:1508961020
Name:ACKER, KENNETH DIXON JR
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DIXON
Last Name:ACKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 SUNSET BLVD
Mailing Address - Street 2:COLUMBIA REHABILITATION CLINIC
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6863
Mailing Address - Country:US
Mailing Address - Phone:803-794-3440
Mailing Address - Fax:803-791-3862
Practice Address - Street 1:1177 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6863
Practice Address - Country:US
Practice Address - Phone:803-794-3440
Practice Address - Fax:803-791-3862
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4243208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation