Provider Demographics
NPI:1275626178
Name:KENNEDY, JAMES DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
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 1:13348 POWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4626
Mailing Address - Country:US
Mailing Address - Phone:858-748-3900
Mailing Address - Fax:858-748-8260
Practice Address - Street 1:13348 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4626
Practice Address - Country:US
Practice Address - Phone:858-748-3900
Practice Address - Fax:858-748-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0124430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUT17351Medicare ID - Type UnspecifiedMEDICARE
CA0124430Medicare UPIN