MEDICARE: WHIDDEN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH8151	FL

General Provider Information

NPI Number	:	1508137639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHIDDEN, INC.

Provider Business Mailing Address
First Line	:	501 HARBOR BLVD STE C
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2348
Country	:	US
Telephone Number	:	850-654-1850
Fax Number	:	850-654-9994

Provider Business Practice Location Address
First Line	:	501 HARBOR BLVD STE C
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2348
Country	:	US
Telephone Number	:	850-654-1850
Fax Number	:	850-654-9994

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. KENNETH D WHIDDEN
Credential	:	D.C.
Telephone Number	:	850-654-1850

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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Practice Location Address:

501 HARBOR BLVD STE C
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Directions to “WHIDDEN, INC. ” Practice Location

Language	Start Address	Practice Location

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