Provider Demographics
NPI:1255318614
Name:KENNEDY, SCOTT AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:AARON
Last Name:KENNEDY
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 1:5690 WATERMELON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5009
Mailing Address - Country:US
Mailing Address - Phone:205-409-6665
Mailing Address - Fax:205-310-3478
Practice Address - Street 1:5690 WATERMELON RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-343-0904
Practice Address - Fax:205-343-6700
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2778852001OtherCIGNA
350054728OtherRAIL ROAD MEDICARE