Provider Demographics
NPI:1568526747
Name:KINLAW, TILDEN D (DC)
Entity type:Individual
Prefix:DR
First Name:TILDEN
Middle Name:D
Last Name:KINLAW
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 1:4902 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2110
Mailing Address - Country:US
Mailing Address - Phone:910-739-6000
Mailing Address - Fax:910-739-1792
Practice Address - Street 1:1730 LAKE WOODMOOR DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9215
Practice Address - Country:US
Practice Address - Phone:719-212-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908543Medicaid
NC7908543Medicaid
NC2453916Medicare ID - Type UnspecifiedMEDICARE