Provider Demographics
NPI:1619090842
Name:JOHN KENNEDY DC PC
Entity Type:Organization
Organization Name:JOHN KENNEDY DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-979-5692
Mailing Address - Street 1:1951 HOOVER CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3606
Mailing Address - Country:US
Mailing Address - Phone:205-979-5692
Mailing Address - Fax:205-979-3697
Practice Address - Street 1:1951 HOOVER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3606
Practice Address - Country:US
Practice Address - Phone:205-979-5692
Practice Address - Fax:205-979-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1795111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51511287OtherBCBS AL
AL27-1006696OtherNEW BUSINESS EIN
AL51511287OtherBCBS AL
AL51511287OtherBCBS AL
AL=========OtherEIN