Provider Demographics
NPI:1689771941
Name:FINE, KENNETH SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SCOTT
Last Name:FINE
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 1:22330 SHERMAN WAY
Mailing Address - Street 2:2C
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-704-7211
Mailing Address - Fax:818-347-2436
Practice Address - Street 1:22330 SHERMAN WAY
Practice Address - Street 2:2C
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-704-7211
Practice Address - Fax:818-347-2436
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69531Medicare UPIN
CADC25325Medicare ID - Type Unspecified