Provider Demographics
NPI:1073061156
Name:ROZELL, KENNETH RYAN (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RYAN
Last Name:ROZELL
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 1:2725 JAMES SANDERS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8405
Mailing Address - Country:US
Mailing Address - Phone:618-709-2401
Mailing Address - Fax:
Practice Address - Street 1:3 SUNSET HILLS PROFESSIONAL CENTER
Practice Address - Street 2:SUITE 2
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025
Practice Address - Country:US
Practice Address - Phone:618-709-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor