Provider Demographics
NPI:1457517609
Name:MONGER, KENNETH ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROY
Last Name:MONGER
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:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122
Mailing Address - Country:US
Mailing Address - Phone:970-884-2082
Mailing Address - Fax:970-884-2963
Practice Address - Street 1:1327 HWY 160B
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:970-884-2082
Practice Address - Fax:970-884-2963
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6265111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor