MEDICARE: KME CHIRO 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	111NN1001X	Nutrition Chiropractor	CH7937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HZ055A	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1952839805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KME CHIRO INC

Provider Business Mailing Address
First Line	:	3202 DR MARTIN LUTHER KING ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	17276372957
Fax Number	:

Provider Business Practice Location Address
First Line	:	3202 DR MARTIN LUTHER KING ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-1202
Country	:	US
Telephone Number	:	172-763-7295
Fax Number	:	727-637-2957

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTIN KIDGELL
Credential	:	D.C
Telephone Number	:	727-637-2957

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	06/16/2018

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Directions to “KME CHIRO INC ” Practice Location

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