Organization
DEMAREST CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DEMAREST D.C. (OWNER/ADMINISTRATOR/CHIROPRACTOR)
(860) 296-0090
Entity
Organization
Contact information
Practice address
740 MAPLE AVE, HARTFORD, CT 06114-2314
(860) 296-0090
Mailing address
740 MAPLE AVE, HARTFORD, CT 06114-2314
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
001360
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001360
D.C. STATE LICENSE#
CT
01
—
050001360CT04
BCBS
CT
01
—
1034337
ASHN/CIGNA
CT
01
—
10450156
CAQH
CT
01
—
1289267
AETNA HMO
CT
01
—
7163301
AETNA NON HMO/PPO
CT
01
—
CT0847
LANDMARK/HEALTHNET
CT
Enumeration date
07/28/2006
Last updated
08/22/2020
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