Provider Demographics
NPI:1992792550
Name:STRATHDEE, KEVIN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:STRATHDEE
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 1:2121 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76106-8588
Mailing Address - Country:US
Mailing Address - Phone:817-624-7222
Mailing Address - Fax:817-665-1865
Practice Address - Street 1:2121 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106-8588
Practice Address - Country:US
Practice Address - Phone:817-624-7222
Practice Address - Fax:817-665-1865
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU60192Medicare UPIN
TX8D2127Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER