Provider Demographics
NPI:1639594237
Name:KENNEY- WRIGHT, JEREMIAH (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:KENNEY- WRIGHT
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 1:351 N RONALD REAGAN BLVD STE 1015
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4159
Mailing Address - Country:US
Mailing Address - Phone:407-417-2533
Mailing Address - Fax:
Practice Address - Street 1:351 N RONALD REAGAN BLVD STE 1015
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4159
Practice Address - Country:US
Practice Address - Phone:407-417-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012730111N00000X
FLCH11126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor