Provider Demographics
NPI:1760566632
Name:KITCHING, KENNETH J (DC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:KITCHING
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RUSHING LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-6027
Mailing Address - Country:US
Mailing Address - Phone:912-681-2225
Mailing Address - Fax:912-871-2225
Practice Address - Street 1:110 RUSHING LN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-6027
Practice Address - Country:US
Practice Address - Phone:912-681-2225
Practice Address - Fax:912-871-2225
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00748129AMedicaid
GA35ZCDCZMedicare ID - Type Unspecified
GA00748129AMedicaid