Provider Demographics
NPI:1811036189
Name:D G KENNY DC SC
Entity Type:Organization
Organization Name:D G KENNY DC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-487-3832
Mailing Address - Street 1:1421 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ALGOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54201-1449
Mailing Address - Country:US
Mailing Address - Phone:920-487-3832
Mailing Address - Fax:920-487-5809
Practice Address - Street 1:1421 LAKE ST
Practice Address - Street 2:
Practice Address - City:ALGOMA
Practice Address - State:WI
Practice Address - Zip Code:54201-1449
Practice Address - Country:US
Practice Address - Phone:920-487-3832
Practice Address - Fax:920-487-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty