Provider Demographics
NPI:1689741274
Name:LOMMEL, KENNETH M (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:LOMMEL
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 1:517 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3122
Mailing Address - Country:US
Mailing Address - Phone:919-663-3137
Mailing Address - Fax:
Practice Address - Street 1:517 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3122
Practice Address - Country:US
Practice Address - Phone:919-663-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1731111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890858Medicaid
NC890858Medicaid
NCT40902Medicare UPIN