Provider Demographics
NPI:1508404286
Name:LENNEHAN, KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LENNEHAN
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 1:17 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-3162
Mailing Address - Country:US
Mailing Address - Phone:860-810-5382
Mailing Address - Fax:
Practice Address - Street 1:300 ALUMNI RD
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-1868
Practice Address - Country:US
Practice Address - Phone:860-578-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor