Provider Demographics
NPI:1629113725
Name:KENNEDY, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KENNEDY
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 1:1951 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:205-979-6899
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1795111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL271006696OtherTAX ID
AL11287OtherBCBS OF AL PROVIDER NO.
AL11287OtherBCBS OF AL PROVIDER NO.
ALU68554Medicare UPIN