Provider Demographics
NPI:1285740993
Name:HILL, KENT RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:RICHARD
Last Name:HILL
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 1:1014 EAGLERIDGE BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2165
Mailing Address - Country:US
Mailing Address - Phone:719-544-1500
Mailing Address - Fax:719-544-1568
Practice Address - Street 1:1014 EAGLERIDGE BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2165
Practice Address - Country:US
Practice Address - Phone:719-544-1500
Practice Address - Fax:719-544-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor