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Individual
KELLY J. ROUSH ICENHOWER
Active
Individual
KELLY J. ROUSH ICENHOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2510
OH
111N00000X
Chiropractor
2510
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007692
ANTHEM BCBS
—
01
—
000000185276
UNISON MEDICAID
OH
01
—
001714092
MOUNTAIN STATE BCBS
—
05
—
0132242000
—
WV
05
—
2026677
—
OH
01
—
310917085149
CARESOURCE MEDICAID
OH
01
—
350039394
RR MEDICARE
—
Enumeration date
06/08/2006
Last updated
07/01/2020
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