Provider Demographics
NPI:1194703322
Name:REINHART, KENNETH ROLLAND (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROLLAND
Last Name:REINHART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:R
Other - Last Name:REINHART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3190 MLK ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2037
Mailing Address - Country:US
Mailing Address - Phone:727-822-2233
Mailing Address - Fax:727-894-3476
Practice Address - Street 1:3190 MLK ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2037
Practice Address - Country:US
Practice Address - Phone:727-822-2233
Practice Address - Fax:727-894-3476
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005728111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
T96187Medicare UPIN
22484Medicare ID - Type Unspecified