Provider Demographics
NPI:1881693620
Name:RAFFERTY, KENNETH C (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:RAFFERTY
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 1:143 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2129
Mailing Address - Country:US
Mailing Address - Phone:603-524-3222
Mailing Address - Fax:
Practice Address - Street 1:143 LAKE ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2129
Practice Address - Country:US
Practice Address - Phone:603-524-3222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH314-A111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH314-AOtherNH STATE LICENSE CERTIFIC
NHT25811Medicare UPIN
NHNH8653Medicare ID - Type Unspecified