Provider Demographics
NPI:1528142189
Name:KITA, KEVIN KOJI (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KOJI
Last Name:KITA
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:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-0714
Mailing Address - Country:US
Mailing Address - Phone:215-736-9291
Mailing Address - Fax:609-737-1094
Practice Address - Street 1:375 W TRENTON AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-3516
Practice Address - Country:US
Practice Address - Phone:215-736-9291
Practice Address - Fax:609-737-1094
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007140L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC007140LOtherCHIROPRACTIC LICENSE