Provider Demographics
NPI:1194894881
Name:KOTHEIMER, WILLIAM P (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:KOTHEIMER
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 1:201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-0123
Mailing Address - Country:US
Mailing Address - Phone:513-871-4092
Mailing Address - Fax:513-871-4092
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-0123
Practice Address - Country:US
Practice Address - Phone:513-871-4092
Practice Address - Fax:513-871-4092
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
34123263900OtherWORKERS COMP
000000025485OtherANTHEM BC BS INS
T46993Medicare UPIN
000000025485OtherANTHEM BC BS INS