Provider Demographics
NPI:1467734608
Name:KENNEDY, JODI ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:ELIZABETH
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 1:874 WHIPPLE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8901
Mailing Address - Country:US
Mailing Address - Phone:843-400-4087
Mailing Address - Fax:843-636-5689
Practice Address - Street 1:874 WHIPPLE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8901
Practice Address - Country:US
Practice Address - Phone:843-400-4087
Practice Address - Fax:843-636-5689
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor