Provider Demographics
NPI:1740387497
Name:KENNEDY, MICHAEL ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
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:PO BOX 59
Mailing Address - Street 2:701 S SECOND ST
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012
Mailing Address - Country:US
Mailing Address - Phone:712-225-2423
Mailing Address - Fax:712-225-2621
Practice Address - Street 1:701 S SECOND ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012
Practice Address - Country:US
Practice Address - Phone:712-225-2423
Practice Address - Fax:712-225-2621
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA009753Medicaid
IA009753Medicaid