Provider Demographics
NPI:1629150164
Name:COHEN, KATIE V (CH)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:V
Last Name:COHEN
Suffix:
Gender:F
Credentials:CH
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:VANESSA
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1500 CENTRAL AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4198
Mailing Address - Country:US
Mailing Address - Phone:513-267-1908
Mailing Address - Fax:
Practice Address - Street 1:1500 CENTRAL AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4198
Practice Address - Country:US
Practice Address - Phone:513-267-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744221Medicaid
OH2744221Medicaid
OH4170482Medicare PIN