Provider Demographics
NPI:1467572248
Name:KENNEDY, KRISTINA M (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:M
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 1:553 E. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-592-4631
Mailing Address - Fax:888-633-3789
Practice Address - Street 1:553 E. STATE STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-592-4631
Practice Address - Fax:888-633-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2736007Medicaid
OH2736007Medicaid
KE4204821Medicare PIN