Provider Demographics
NPI:1326080151
Name:DEMERS, KEVIN J (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:DEMERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 S HOPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4744
Mailing Address - Country:US
Mailing Address - Phone:321-264-0072
Mailing Address - Fax:321-264-3370
Practice Address - Street 1:2208 S HOPKINS AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4744
Practice Address - Country:US
Practice Address - Phone:321-264-0072
Practice Address - Fax:321-264-3370
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88631OtherBLUE SHIELD
FLV02967Medicare UPIN
FL88631ZMedicare ID - Type Unspecified