Individual
DR. KENNETH STEVEN HIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1131 S INDIANA AVE, GOSHEN, IN 46526-6207
(574) 533-0770
(574) 534-0770
Mailing address
1131 S INDIANA AVE, GOSHEN, IN 46526-6207
(574) 533-0770
(574) 534-0770
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001551
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000387548
ANTHEM
IN
Enumeration date
07/27/2006
Last updated
07/08/2007
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