# DR. KENNETH DEMAREST

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1134133846
- **Gender:** Man
- **Credential:** D.C.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 001360 | CT | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 07/08/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001360 | STATE LICENSE \# | CT |
| 01 | — | 050001360CT04 | BCBS | CT |
| 01 | — | 1034337 | ASHN | CT |
| 01 | — | 10450156 | CAQH | CT |
| 01 | — | 1289267 | AETNA HMO\# | CT |
| 01 | — | 7163301 | AETNA NON HMO/PPO\# | CT |
| 01 | — | CT0847 | LANDMARK/HEALTH NET | CT |