Provider Demographics
NPI:1922540798
Name:TATE, KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:TATE
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 1:811 THREADNEEDLE ST APT 278
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2863
Mailing Address - Country:US
Mailing Address - Phone:713-203-9797
Mailing Address - Fax:
Practice Address - Street 1:1926 AVENUE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1659
Practice Address - Country:US
Practice Address - Phone:713-203-9797
Practice Address - Fax:281-574-5624
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor