Provider Demographics
NPI:1902810773
Name:DEMAREST CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DEMAREST CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAREST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-296-0090
Mailing Address - Street 1:740 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2314
Practice Address - Country:US
Practice Address - Phone:860-296-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001360CT04OtherBCBS
CT7163301OtherAETNA NON HMO/PPO
CT1289267OtherAETNA HMO
CT1034337OtherASHN/CIGNA
CT10450156OtherCAQH
CTCT0847OtherLANDMARK/HEALTHNET
CT001360OtherD.C. STATE LICENSE#
CT050001360CT04OtherBCBS