Provider Demographics
NPI:1376790535
Name:KENNEDY, NINA RICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:RICHELLE
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 1:140 SAGE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-0957
Mailing Address - Country:US
Mailing Address - Phone:864-848-0640
Mailing Address - Fax:864-848-0646
Practice Address - Street 1:140 SAGE CREEK WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-0957
Practice Address - Country:US
Practice Address - Phone:864-848-0640
Practice Address - Fax:864-848-0646
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor