Provider Demographics
NPI:1225077688
Name:KENKEL FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KENKEL FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:V
Authorized Official - Last Name:KENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-527-5800
Mailing Address - Street 1:502 SHARP ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1731
Mailing Address - Country:US
Mailing Address - Phone:712-527-5800
Mailing Address - Fax:712-527-2065
Practice Address - Street 1:502 SHARP ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1731
Practice Address - Country:US
Practice Address - Phone:712-527-5800
Practice Address - Fax:712-527-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16895Medicare ID - Type Unspecified