Healthcare Provider Details

I. General information

NPI: 1053485292
Provider Name (Legal Business Name): KENNETH ROBERT HOFFMAN D.AC., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OLD ROUTE 7
BROOKFIELD CT
06804-2041
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-2041
US

V. Phone/Fax

Practice location:
  • Phone: 203-740-9300
  • Fax: 203-740-9301
Mailing address:
  • Phone: 203-740-9300
  • Fax: 203-740-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000314
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: