Provider Demographics
NPI:1225476591
Name:KENNEDY, CARRI LYNN (DC)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:LYNN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109A S CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-1237
Mailing Address - Country:US
Mailing Address - Phone:715-539-9797
Mailing Address - Fax:715-539-9098
Practice Address - Street 1:109A S CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-1237
Practice Address - Country:US
Practice Address - Phone:715-539-9797
Practice Address - Fax:715-539-9098
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4971-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor