Provider Demographics
NPI:1518030501
Name:KENNELL, JAMES F
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:KENNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W. BANDERA
Mailing Address - Street 2:SUITE 114 PMB 406
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9998
Mailing Address - Country:US
Mailing Address - Phone:830-249-8900
Mailing Address - Fax:830-249-8923
Practice Address - Street 1:115 HWY 46 W
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9998
Practice Address - Country:US
Practice Address - Phone:830-249-8900
Practice Address - Fax:830-249-8923
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 8054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU72264Medicare UPIN
TX8B7781Medicare ID - Type Unspecified