Provider Demographics
NPI:1700876729
Name:WHIDDEN, KENNETH DAVIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DAVIS
Last Name:WHIDDEN
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:501 HARBOR BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2348
Mailing Address - Country:US
Mailing Address - Phone:850-654-1850
Mailing Address - Fax:850-654-9994
Practice Address - Street 1:501 HARBOR BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2348
Practice Address - Country:US
Practice Address - Phone:850-654-1850
Practice Address - Fax:850-654-9994
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH8151111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381569200Medicaid
FLU84346Medicare UPIN
FL381569200Medicaid