Provider Demographics
NPI:1417266016
Name:GODWIN, KENYON (DC)
Entity Type:Individual
Prefix:DR
First Name:KENYON
Middle Name:
Last Name:GODWIN
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 1:5001 S COOPER ST
Mailing Address - Street 2:STE 210
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5992
Mailing Address - Country:US
Mailing Address - Phone:817-557-2770
Mailing Address - Fax:817-557-1795
Practice Address - Street 1:5001 S COOPER ST STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5993
Practice Address - Country:US
Practice Address - Phone:817-557-2770
Practice Address - Fax:817-557-1795
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor