Provider Demographics
NPI:1194976316
Name:DK ACUPUNCTURE AND CHIROPRACTIC CORP
Entity type:Organization
Organization Name:DK ACUPUNCTURE AND CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KENEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-956-9393
Mailing Address - Street 1:2221 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2455
Mailing Address - Country:US
Mailing Address - Phone:863-956-9393
Mailing Address - Fax:863-956-9393
Practice Address - Street 1:880 S LAKESHORE WAY
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:FL
Practice Address - Zip Code:33850-3320
Practice Address - Country:US
Practice Address - Phone:863-956-9393
Practice Address - Fax:863-956-9393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DK ACUPUNCTURE AND CHIROPRACTIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH001514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty