Provider Demographics
NPI:1801026265
Name:KENNEDY, ARTHUR FREDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:FREDERICK
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 1038
Mailing Address - Street 2:
Mailing Address - City:NAALEHU
Mailing Address - State:HI
Mailing Address - Zip Code:96772-1038
Mailing Address - Country:US
Mailing Address - Phone:808-494-7920
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1038
Practice Address - Street 2:
Practice Address - City:NAALEHU
Practice Address - State:HI
Practice Address - Zip Code:96772
Practice Address - Country:US
Practice Address - Phone:808-961-6888
Practice Address - Fax:808-961-6887
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HICL254AOtherMEDICARE PTAN