Healthcare Provider Details

I. General information

NPI: 1194716951
Provider Name (Legal Business Name): THOMAS W KEMP D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N ESKEW RD
BOONVILLE IN
47601-7707
US

IV. Provider business mailing address

1044 N ESKEW RD
BOONVILLE IN
47601-7707
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-1700
  • Fax: 812-897-0071
Mailing address:
  • Phone: 812-897-1700
  • Fax: 812-897-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002171A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: