Provider Demographics
NPI:1952378077
Name:GARVEY, KENNETH JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAMES
Last Name:GARVEY
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 1:3349 G ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0978
Mailing Address - Country:US
Mailing Address - Phone:209-726-3000
Mailing Address - Fax:
Practice Address - Street 1:3349 G ST
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0978
Practice Address - Country:US
Practice Address - Phone:209-726-3000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0262840Medicare ID - Type Unspecified