Provider Demographics
NPI:1841275385
Name:KSE CHIROPRACTIC INC.
Entity type:Organization
Organization Name:KSE CHIROPRACTIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERETH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-773-0505
Mailing Address - Street 1:8251 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4602
Mailing Address - Country:US
Mailing Address - Phone:623-773-0505
Mailing Address - Fax:623-773-0405
Practice Address - Street 1:8251 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4602
Practice Address - Country:US
Practice Address - Phone:623-773-0505
Practice Address - Fax:623-773-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4824111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0910420OtherBCBS
AZAZ0910420OtherBCBS
AZU24993Medicare UPIN
AZZ101944Medicare PIN
AZ=========OtherCOMMERCIAL INS.