Provider Demographics
NPI:1700225018
Name:KENSHO TOTAL WELLNESS DAY SPA, LLC
Entity Type:Organization
Organization Name:KENSHO TOTAL WELLNESS DAY SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-249-7377
Mailing Address - Street 1:37 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3904
Mailing Address - Country:US
Mailing Address - Phone:970-249-7377
Mailing Address - Fax:
Practice Address - Street 1:37 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3904
Practice Address - Country:US
Practice Address - Phone:970-249-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC48093Medicare PIN