=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265345490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KH WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 BROOKES DR STE 202
-----------------------------------------------------
City | HAZELWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63042-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-399-9170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3625 OREGON AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63118-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-688-7941
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. KENNISHA HARRIS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 314-399-9170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------