Kenneth Richard Degroat, D.C.
Individual provider Active NPI Chiropractor · Keyport, NJ
NPI 1841338043 · NPPES record last updated Oct 30, 2007
Key facts
- NPI
- 1841338043
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3108 (NJ)
- Practice address
- 333 Main St
Keyport, NJ 07735-1469 - Phone
- (732) 888-0343
- Fax
- (732) 888-9145
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3108 | NJ | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3108 | NJ | Yes |
Addresses
Primary practice location
333 Main St
Keyport, NJ 07735-1469
Mailing address
333 Main St
Keyport, NJ 07735-1469
Phone (732) 888-0343
Other providers in Keyport, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.