Provider Demographics
NPI:1043429822
Name:MICHAEL KENNEDY, D.C., P.C.
Entity Type:Organization
Organization Name:MICHAEL KENNEDY, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CLARKSON
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-949-0600
Mailing Address - Street 1:7730 E MCDOWELL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3772
Mailing Address - Country:US
Mailing Address - Phone:480-949-0600
Mailing Address - Fax:480-949-6670
Practice Address - Street 1:7730 E MCDOWELL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3772
Practice Address - Country:US
Practice Address - Phone:480-949-0600
Practice Address - Fax:480-949-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1096111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty