Provider Demographics
NPI:1649398389
Name:KENUL, ROBERT A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:KENUL
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 1:987 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3532
Mailing Address - Country:US
Mailing Address - Phone:631-758-6262
Mailing Address - Fax:631-758-1660
Practice Address - Street 1:987 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3532
Practice Address - Country:US
Practice Address - Phone:631-758-6262
Practice Address - Fax:631-758-1660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004534-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-2967495OtherFEDERAL TAX I.D. NUMBER
NYX34801Medicare ID - Type Unspecified