Provider Demographics
NPI:1407382054
Name:HART, KENNETH RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RYAN
Last Name:HART
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 1:704 JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-1539
Mailing Address - Country:US
Mailing Address - Phone:609-618-9246
Mailing Address - Fax:
Practice Address - Street 1:7 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2242
Practice Address - Country:US
Practice Address - Phone:732-935-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00744400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor