MEDICARE: DR. TILDEN D KINLAW D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0008444	CO

General Provider Information

NPI Number	:	1568526747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TILDEN D KINLAW D.C.

Provider Business Mailing Address
First Line	:	4902 FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2110
Country	:	US
Telephone Number	:	910-739-6000
Fax Number	:	910-739-1792

Provider Business Practice Location Address
First Line	:	1730 LAKE WOODMOOR DR
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9215
Country	:	US
Telephone Number	:	719-212-8996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	12/09/2024

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