MEDICARE: KENNETH J. VINTON D.C.

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	DC004038L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	409007	OTHER	PA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000609608	OTHER	PA	KEYSTONE BLUE WEST

General Provider Information

NPI Number	:	1992781769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH J. VINTON D.C.

Provider Business Mailing Address
First Line	:	190 GEORGE JUNIOR RD
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-4414
Country	:	US
Telephone Number	:	724-458-1000
Fax Number	:	888-561-7937

Provider Business Practice Location Address
First Line	:	190 GEORGE JUNIOR RD
Second Line	:
City	:	GROVE CITY
State	:	PA
Zip	:	16127-4414
Country	:	US
Telephone Number	:	724-458-1100
Fax Number	:	888-561-7937

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	10/12/2016

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