Provider Demographics
NPI:1013905223
Name:EBLING, KENT RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:RICHARD
Last Name:EBLING
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 1:11 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8439
Mailing Address - Country:US
Mailing Address - Phone:954-782-2066
Mailing Address - Fax:954-782-2066
Practice Address - Street 1:11 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8439
Practice Address - Country:US
Practice Address - Phone:954-782-2066
Practice Address - Fax:954-782-2066
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382273700Medicaid
FL350032963OtherRAILROAD MEDICARE
FL382273700Medicaid
FLU12695Medicare UPIN