Provider Demographics
NPI:1851444053
Name:NIEMAN, KENNETH J (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:NIEMAN
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 1:206 N. RANDOLPH
Mailing Address - Street 2:SUITE 422
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820
Mailing Address - Country:US
Mailing Address - Phone:217-356-7077
Mailing Address - Fax:217-352-7444
Practice Address - Street 1:206 N. RANDOLPH
Practice Address - Street 2:SUITE 422
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:217-356-7077
Practice Address - Fax:217-352-7444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor