Provider Demographics
NPI:1790717254
Name:CLENIN, KENNETH P (DC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:P
Last Name:CLENIN
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 1:1069 WEST REX RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3819
Mailing Address - Country:US
Mailing Address - Phone:901-683-5971
Mailing Address - Fax:901-683-7336
Practice Address - Street 1:1069 WEST REX RD
Practice Address - Street 2:STE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3819
Practice Address - Country:US
Practice Address - Phone:901-683-5971
Practice Address - Fax:901-683-7336
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0050643OtherBCBS TN
TN3068989002OtherCIGNA
TN3673607Medicare PIN
TN3068989002OtherCIGNA