Provider Demographics
NPI:1003064528
Name:KENNY CLINIC OF CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:KENNY CLINIC OF CHIROPRACTIC, P.A.
Other - Org Name:KENNY WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-889-3831
Mailing Address - Street 1:P.O. B. 2452
Mailing Address - Street 2:2400 S. MAIN ST.
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27263
Mailing Address - Country:US
Mailing Address - Phone:336-889-3831
Mailing Address - Fax:336-889-7269
Practice Address - Street 1:2400 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263
Practice Address - Country:US
Practice Address - Phone:336-889-3831
Practice Address - Fax:336-889-7269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNY CLINIC OF CHIROPRACTIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1054111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08557OtherBLUE CROSS BLUE SHIELD INS.
NC3105OtherPARTNERS INS.
244317Medicare PIN
NC08557OtherBLUE CROSS BLUE SHIELD INS.