Provider Demographics
NPI:1992781769
Name:VINTON, KENNETH J (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:VINTON
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 1:190 GEORGE JUNIOR RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4414
Mailing Address - Country:US
Mailing Address - Phone:724-458-1000
Mailing Address - Fax:888-561-7937
Practice Address - Street 1:190 GEORGE JUNIOR RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-4414
Practice Address - Country:US
Practice Address - Phone:724-458-1100
Practice Address - Fax:888-561-7937
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004038L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA409007OtherMEDICARE ID
PA000609608OtherKEYSTONE BLUE WEST
PA7353780001Medicare NSC
PAU14256Medicare UPIN