Provider Demographics
NPI:1962503219
Name:KEDING, STEPHEN E
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:KEDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1789
Mailing Address - Country:US
Mailing Address - Phone:740-676-2691
Mailing Address - Fax:740-676-2707
Practice Address - Street 1:360 28TH ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1789
Practice Address - Country:US
Practice Address - Phone:740-676-2691
Practice Address - Fax:740-676-2707
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1963111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131456000Medicaid
OH2013958Medicaid
WV0131456000Medicaid