Provider Demographics
NPI:1346370012
Name:KENNEDY CHIROPRACTIC OFFICE, P.C.
Entity Type:Organization
Organization Name:KENNEDY CHIROPRACTIC OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-225-2423
Mailing Address - Street 1:701 S 2ND ST
Mailing Address - Street 2:P O BOX 59
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-2178
Mailing Address - Country:US
Mailing Address - Phone:712-225-2423
Mailing Address - Fax:712-225-2621
Practice Address - Street 1:701 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-2178
Practice Address - Country:US
Practice Address - Phone:712-225-2423
Practice Address - Fax:712-225-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2982111N00000X
IA4618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0445650Medicaid
IACH1451OtherRAILROAD
IA0445650Medicaid