MEDICARE: KENA AIDEN MCDERMOTT 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	2156	CT

General Provider Information

NPI Number	:	1275187833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENA AIDEN MCDERMOTT DC

Provider Business Mailing Address
First Line	:	299 COLT HWY APT 514
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-3095
Country	:	US
Telephone Number	:	715-383-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 FARMINGTON AVE STE 304
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-2673
Country	:	US
Telephone Number	:	715-383-4158
Fax Number	:

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

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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