Healthcare Provider Details

I. General information

NPI: 1730239609
Provider Name (Legal Business Name): KEVIN J MCDERMOTT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 FOX HUNT DR
BEAR DE
19701-2534
US

IV. Provider business mailing address

560 HEMINGWAY DR
HOCKESSIN DE
19707-1109
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-6150
  • Fax: 302-836-6294
Mailing address:
  • Phone: 302-234-1454
  • Fax: 302-836-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberF1-0000451
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: