Provider Demographics
NPI:1598821357
Name:KOLES, KENNETH RICHARD (PHD DSC LAC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RICHARD
Last Name:KOLES
Suffix:
Gender:M
Credentials:PHD DSC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1331
Mailing Address - Country:US
Mailing Address - Phone:216-397-4950
Mailing Address - Fax:216-397-4044
Practice Address - Street 1:2565 WARWICK RD
Practice Address - Street 2:
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44120-1331
Practice Address - Country:US
Practice Address - Phone:216-397-4950
Practice Address - Fax:216-397-4044
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65000028171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist