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General NPI Number Information
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NPI Number | 1902810773
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Entity Type | Organization
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Legal Business Name | DEMAREST CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 740 MAPLE AVE
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City | HARTFORD
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State | CT
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Zip | 06114-2314
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Country | US
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Telephone | 860-296-0090
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Fax |
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Provider Business Mailing Address
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Address Line | 740 MAPLE AVE
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City | HARTFORD
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State | CT
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Zip | 06114-2314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR/CHIROPRACTOR
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Name | DR. KENNETH DEMAREST
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Credential | D.C.
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Telephone | 860-296-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 001360
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License Number State | CT
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