Provider Demographics
NPI:1801933874
Name:DECKER, KENNETH M II (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:DECKER
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S. MAIN ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1477
Mailing Address - Country:US
Mailing Address - Phone:302-389-8915
Mailing Address - Fax:302-389-8916
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:SUITE 218
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1477
Practice Address - Country:US
Practice Address - Phone:302-378-8915
Practice Address - Fax:302-378-8916
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE491050Medicare PIN
DEU87447Medicare UPIN