Provider Demographics
NPI:1003825464
Name:POMPILLI, KENNETH SERENO (DC CHIROPRACTIC PHYS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:SERENO
Last Name:POMPILLI
Suffix:
Gender:M
Credentials:DC CHIROPRACTIC PHYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STRAW AVE
Mailing Address - Street 2:STE 6 THE SILK MILL
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1464
Mailing Address - Country:US
Mailing Address - Phone:413-584-5088
Mailing Address - Fax:413-584-2999
Practice Address - Street 1:15 STRAW AVE
Practice Address - Street 2:STE 6 THE SILK MILL
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1464
Practice Address - Country:US
Practice Address - Phone:413-584-5088
Practice Address - Fax:413-584-2999
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA351093OtherHARVARD PILGRIM
MAY35060OtherBCBS OF MA
MAPOY35060Medicare Oscar/Certification