Individual
DR. KEVIN JOHN DEFRIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5529 W STATE ROAD 10, PO 238, DEMOTTE, IN 46310-8799
(219) 987-7333
(219) 987-7749
Mailing address
5529 W STATE ROAD 10, PO 238, DEMOTTE, IN 46310-8799
(219) 987-7333
(219) 987-7749
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001292
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000203794
ANTHEM
IN
Enumeration date
07/31/2006
Last updated
07/09/2007
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