Provider Demographics
NPI:1700921178
Name:CHILLICOTHE CHIROPRACTIC AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:CHILLICOTHE CHIROPRACTIC AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-775-9995
Mailing Address - Street 1:190 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2620
Mailing Address - Country:US
Mailing Address - Phone:740-775-9995
Mailing Address - Fax:740-775-9997
Practice Address - Street 1:190 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2620
Practice Address - Country:US
Practice Address - Phone:740-775-9995
Practice Address - Fax:740-775-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9333021Medicare PIN