Provider Demographics
NPI:1871632117
Name:KIRCHNER, ETHAN MILES (DC)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:MILES
Last Name:KIRCHNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2206 LAFAYETTE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1043
Mailing Address - Country:US
Mailing Address - Phone:765-362-0123
Mailing Address - Fax:765-362-8479
Practice Address - Street 1:508 ROCK SPRING AVE.
Practice Address - Street 2:STE 100
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-836-0001
Practice Address - Fax:410-893-6373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDS02127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD862MMedicare ID - Type Unspecified