Provider Demographics
NPI:1780182774
Name:GUERIN, KENNETH GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GERARD
Last Name:GUERIN
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 1:19 TIMBER MILL LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2727
Mailing Address - Country:US
Mailing Address - Phone:203-247-9320
Mailing Address - Fax:
Practice Address - Street 1:256 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3620
Practice Address - Country:US
Practice Address - Phone:203-247-9320
Practice Address - Fax:203-247-9320
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor