Provider Demographics
NPI:1639256340
Name:SVENINGSON, KENT ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALAN
Last Name:SVENINGSON
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 1:3 MONARCH BAY PLZ
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3440
Mailing Address - Country:US
Mailing Address - Phone:949-218-7671
Mailing Address - Fax:949-371-8056
Practice Address - Street 1:3 MONARCH BAY PLZ
Practice Address - Street 2:SUITE 109
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3440
Practice Address - Country:US
Practice Address - Phone:949-218-7671
Practice Address - Fax:949-371-8056
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21528Medicare PIN