Provider Demographics
NPI:1902997828
Name:KITTLE, JENA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENA
Middle Name:LOUISE
Last Name:KITTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12049 S STRANG LINE RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5256
Mailing Address - Country:US
Mailing Address - Phone:913-768-4455
Mailing Address - Fax:913-393-3729
Practice Address - Street 1:12049 S STRANG LINE RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5256
Practice Address - Country:US
Practice Address - Phone:913-768-4455
Practice Address - Fax:913-393-3729
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP002997828OtherRAILROAD MEDICARE
KS36135016OtherBCBS PROVIDER #
KS36098018OtherBCBS GROUP BILLING #
KSP002997828OtherRAILROAD MEDICARE