Provider Demographics
NPI:1093838591
Name:ROBERT MARK KENNEDY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ROBERT MARK KENNEDY CHIROPRACTIC INC
Other - Org Name:RMKC INC MOTION X-RAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-430-8501
Mailing Address - Street 1:11022 WINNERS CIR STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2883
Mailing Address - Country:US
Mailing Address - Phone:562-430-8501
Mailing Address - Fax:
Practice Address - Street 1:6557 E PACIFIC COAST HWY # H-10
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4202
Practice Address - Country:US
Practice Address - Phone:562-430-8501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18477111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty