Provider Demographics
NPI:1811027295
Name:KENWOOD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KENWOOD FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-792-0070
Mailing Address - Street 1:3700 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:513-792-0070
Mailing Address - Fax:513-792-0466
Practice Address - Street 1:6934 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3821
Practice Address - Country:US
Practice Address - Phone:513-792-0070
Practice Address - Fax:513-792-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000350968OtherANTHEM BCBS
OH000000350968OtherANTHEM BCBS