Healthcare Provider Details

I. General information

NPI: 1790840155
Provider Name (Legal Business Name): HEALTH 1ST OF KOKOMO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 SOUTHLAND AVE
KOKOMO IN
46902-3638
US

IV. Provider business mailing address

3807 SOUTHLAND AVE
KOKOMO IN
46902-3638
US

V. Phone/Fax

Practice location:
  • Phone: 765-864-1877
  • Fax: 765-864-1889
Mailing address:
  • Phone: 765-864-1877
  • Fax: 765-864-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002165A
License Number StateIN

VIII. Authorized Official

Name: DR. CHRISTOPHER KEITH WHITEMAN
Title or Position: PRESIDENT
Credential: DC
Phone: 765-864-1877