Provider Demographics
NPI:1821169426
Name:KOHL, JOHN CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:KOHL
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 1:7323 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2113
Mailing Address - Country:US
Mailing Address - Phone:614-861-6222
Mailing Address - Fax:614-861-1940
Practice Address - Street 1:7323 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2113
Practice Address - Country:US
Practice Address - Phone:614-861-6222
Practice Address - Fax:614-861-1940
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKO4097472Medicare ID - Type Unspecified