Healthcare Provider Details

I. General information

NPI: 1508950452
Provider Name (Legal Business Name): KOTKIN CHIROPRACTIC CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 PLAZA DRIVE
WINCHESTER VA
22601
US

IV. Provider business mailing address

1809 PLAZA DRIVE
WINCHESTER VA
22607
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-7300
  • Fax: 540-667-0567
Mailing address:
  • Phone: 540-667-7300
  • Fax: 540-667-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001317
License Number StateVA

VIII. Authorized Official

Name: MICHELLE H KOTKIN
Title or Position: CLINIC OWNER
Credential: DC
Phone: 540-667-7300