Provider Demographics
NPI:1467695916
Name:KENNY, EILEEN JACQUELINE (DC)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:JACQUELINE
Last Name:KENNY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:1911 N. LAKE AVE.
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-1708
Mailing Address - Country:US
Mailing Address - Phone:626-398-0292
Mailing Address - Fax:626-398-8776
Practice Address - Street 1:1911 N. LAKE AVE.
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-1708
Practice Address - Country:US
Practice Address - Phone:626-398-0292
Practice Address - Fax:626-398-8776
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor