Provider Demographics
NPI:1144314121
Name:KGBN INC
Entity type:Organization
Organization Name:KGBN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHWARTZENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-469-6688
Mailing Address - Street 1:8673 FIELDS ERTEL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-8269
Mailing Address - Country:US
Mailing Address - Phone:513-469-6688
Mailing Address - Fax:513-469-6686
Practice Address - Street 1:8673 FIELDS ERTEL RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-8269
Practice Address - Country:US
Practice Address - Phone:513-469-6688
Practice Address - Fax:513-469-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2043845Medicaid
OH0842911Medicare PIN
OH5879350001Medicare NSC
OH2043845Medicaid