# KELLY J. ROUSH ICENHOWER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629018320
- **Gender:** F
- **Credential:** DC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 2510 | OH | Yes |
| 111N00000X | Chiropractor | 2510 | WV | — |

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 07/01/2020

## 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 | — |