Provider Demographics
NPI:1871821736
Name:KI HOLDINGS
Entity Type:Organization
Organization Name:KI HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:IACUONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-531-4972
Mailing Address - Street 1:6027 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1414
Mailing Address - Country:US
Mailing Address - Phone:602-531-4972
Mailing Address - Fax:
Practice Address - Street 1:720 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5396
Practice Address - Country:US
Practice Address - Phone:602-439-1515
Practice Address - Fax:602-439-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ125291Medicare PIN