Individual provider Active NPI

Denton Ki Dearen, DC

  • Chiropractor
  • Benton, AR
National Provider Identifier
1033947536
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
12410 Issued in AR
Practice address
1900 Military Rd Ste 1
Benton, AR 72015-2819
Phone
(479) 381-2070
NPI assigned
Jul 25, 2024
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 12410 AR Primary

Addresses

Primary practice location

1900 Military Rd Ste 1
Benton, AR 72015-2819

Mailing address

1900 Military Rd Ste 1
Benton, AR 72015-2819
Phone (479) 381-2070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241004002800 AR Practitioner - Chiropractic 3173054855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Logan College of Chiropractic, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apex Health LLCGroup PAC ID 9537541347, 2 clinicians

Practice addresses (Care Compare)

1900 Military Rd
Suite 1
Benton, AR 72015-2805

1900 Military Rd
Suite 1
Benton, AR 72015-2819
Phone (501) 315-6390

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12410ARMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Care Associates P a Chiropractor PastSince Jul 28, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1033947536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 MILITARY RD STE 1",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720152819",
            "telephone_number": "479-381-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MILITARY RD STE 1",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720152819",
            "telephone_number": "479-381-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAREN",
        "first_name": "DENTON",
        "middle_name": "KI",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AR",
            "license": "12410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.