Active NPI
Kenneth Yale Davis, D.C. P.C.
- Chiropractor
- Ridgewood, NJ
National Provider Identifier
1073732509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- NJ1600
- Practice address
- 60 W Ridgewood Ave
Ridgewood, NJ 07450-3197 - Phone
- (201) 652-2554
- Fax
- (201) 652-1708
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | NJ1600 | NJ | Primary |
Addresses
Primary practice location
60 W Ridgewood Ave
Ridgewood, NJ 07450-3197
Mailing address
60 W Ridgewood Ave
Ridgewood, NJ 07450-3197
Phone (201) 652-2554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P2059267 | Other | NJ | OXFORD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NJ1600 | NJ | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321833600000",
"number": "1073732509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 W RIDGEWOOD AVE",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074503197",
"telephone_number": "201-652-2554",
"fax_number": "201-652-1708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 W RIDGEWOOD AVE",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074503197",
"telephone_number": "201-652-2554",
"fax_number": "201-652-1708"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KENNETH",
"middle_name": "YALE",
"name_prefix": "Dr.",
"credential": "D.C. P.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2011-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NJ",
"license": "NJ1600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2059267",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.