Provider Demographics
NPI:1386827012
Name:KENNEY CHIROPRACTIC
Entity Type:Organization
Organization Name:KENNEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-641-5516
Mailing Address - Street 1:20 S POWER RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5204
Mailing Address - Country:US
Mailing Address - Phone:480-641-5516
Mailing Address - Fax:480-641-9561
Practice Address - Street 1:20 S POWER RD
Practice Address - Street 2:STE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-5204
Practice Address - Country:US
Practice Address - Phone:480-641-5516
Practice Address - Fax:480-641-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU59220Medicare UPIN
AZZ106251Medicare PIN