Provider Demographics
NPI:1215156070
Name:KENNETH E DEGROOT DC INC
Entity type:Organization
Organization Name:KENNETH E DEGROOT DC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DE GROOT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-475-5600
Mailing Address - Street 1:1401 SILVERSIDE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4400
Mailing Address - Country:US
Mailing Address - Phone:302-475-5600
Mailing Address - Fax:302-475-5940
Practice Address - Street 1:1401 SILVERSIDE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4400
Practice Address - Country:US
Practice Address - Phone:302-475-5600
Practice Address - Fax:302-475-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001073718Medicaid
DE2279331000OtherAMERIHEALTH
DE0001073718Medicaid
DE2279331000OtherAMERIHEALTH