Provider Demographics
NPI:1043411507
Name:KENYON CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:KENYON CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-237-2289
Mailing Address - Street 1:2003 W OWEN K GARRIOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5530
Mailing Address - Country:US
Mailing Address - Phone:580-237-2289
Mailing Address - Fax:580-237-3751
Practice Address - Street 1:2003 W OWEN K GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5530
Practice Address - Country:US
Practice Address - Phone:580-237-2289
Practice Address - Fax:580-237-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK445763396003OtherBLUE CROSS BLUE SHIELD