Healthcare Provider Details

I. General information

NPI: 1265345490
Provider Name (Legal Business Name): KH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BROOKES DR STE 202
HAZELWOOD MO
63042-2740
US

IV. Provider business mailing address

3625 OREGON AVE
SAINT LOUIS MO
63118-3805
US

V. Phone/Fax

Practice location:
  • Phone: 314-399-9170
  • Fax:
Mailing address:
  • Phone: 314-688-7941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KENNISHA HARRIS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 314-399-9170