MEDICARE: DR. KEVIN DANIEL DEROUEN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	038.014421	IL

General Provider Information

NPI Number	:	1093674228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN DANIEL DEROUEN DC

Provider Business Mailing Address
First Line	:	204 S OPPYVILLE RD
Second Line	:
City	:	WATSEKA
State	:	IL
Zip	:	60970-7911
Country	:	US
Telephone Number	:	757-254-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 S KENNEDY DR
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-2137
Country	:	US
Telephone Number	:	815-929-9296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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