Provider Demographics
NPI:1225842974
Name:MOORE BERMUDEZ, KENNETH GENE (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GENE
Last Name:MOORE BERMUDEZ
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 1:8202 STREAMSIDE PL APT 203
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5248
Mailing Address - Country:US
Mailing Address - Phone:787-585-3838
Mailing Address - Fax:
Practice Address - Street 1:827 ROCKVILLE PIKE STE E
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1267
Practice Address - Country:US
Practice Address - Phone:301-521-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor