Provider Demographics
NPI:1609236843
Name:MATTHEW C. KENNEY CHIROPRACTOR, INC.
Entity Type:Organization
Organization Name:MATTHEW C. KENNEY CHIROPRACTOR, INC.
Other - Org Name:NEW BODY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-347-9906
Mailing Address - Street 1:769 W LITTLETON BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2337
Mailing Address - Country:US
Mailing Address - Phone:303-347-9906
Mailing Address - Fax:
Practice Address - Street 1:769 W LITTLETON BLVD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2337
Practice Address - Country:US
Practice Address - Phone:303-347-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO006908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO350001461Medicare PIN