Provider Demographics
NPI:1457467656
Name:PASSERO, KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:PASSERO
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 1:228 W ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1133
Mailing Address - Country:US
Mailing Address - Phone:203-750-0010
Mailing Address - Fax:203-750-0015
Practice Address - Street 1:228 W ROCKS RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1133
Practice Address - Country:US
Practice Address - Phone:203-750-0010
Practice Address - Fax:203-750-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001171Medicare ID - Type Unspecified
CTT78361Medicare PIN