Individual
DR. KENNETH DEMAREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
740 MAPLE AVE, HARTFORD, CT 06114-2314
(860) 296-0090
(860) 296-1520
Mailing address
740 MAPLE AVE, HARTFORD, CT 06114-2314
(860) 296-0090
(860) 296-1520
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
001360
CT
Other
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
Enumeration date
07/28/2006
Last updated
07/08/2007
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