Provider Demographics
NPI:1952412751
Name:BELLOWS, KEVIN RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAYMOND
Last Name:BELLOWS
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 1:25 LINDEMAN DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4782
Mailing Address - Country:US
Mailing Address - Phone:203-373-0315
Mailing Address - Fax:203-373-0367
Practice Address - Street 1:25 LINDEMAN DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4782
Practice Address - Country:US
Practice Address - Phone:203-373-0315
Practice Address - Fax:203-373-0367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000584111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4082187Medicaid
CT350000422Medicare ID - Type Unspecified
CT4082187Medicaid