Healthcare Provider Details

I. General information

NPI: 1437012549
Provider Name (Legal Business Name): THE KITCHELL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 36TH ST STE 200B
VERO BEACH FL
32960-6588
US

IV. Provider business mailing address

1285 36TH ST STE 200B
VERO BEACH FL
32960-6588
US

V. Phone/Fax

Practice location:
  • Phone: 772-254-9009
  • Fax: 877-682-3204
Mailing address:
  • Phone: 772-254-9009
  • Fax: 877-682-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. COLLIN KITCHELL
Title or Position: MD/OWNER
Credential: MD
Phone: 772-254-9009