Provider Demographics
NPI:1578541686
Name:KENYON, CORY LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:LYN
Last Name:KENYON
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 1:1117-A LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-591-2238
Mailing Address - Fax:615-261-1008
Practice Address - Street 1:1117-A LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-591-2238
Practice Address - Fax:615-261-1008
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3879DC111N00000X
TN2344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9931384-00Medicaid
MN628213OtherMEDICA
MN0509OtherHSM
MN84D10DAOtherBCBS
MN9931384-00Medicaid
MN84D10DAOtherBCBS