Provider Demographics
NPI:1740734904
Name:KINCHLOE, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KINCHLOE
Suffix:
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 1:2511 WEDGLEA DR
Mailing Address - Street 2:APT. 223
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2037
Mailing Address - Country:US
Mailing Address - Phone:313-502-6333
Mailing Address - Fax:
Practice Address - Street 1:2511 WEDGLEA DR
Practice Address - Street 2:APT. 223
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2037
Practice Address - Country:US
Practice Address - Phone:313-502-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other