Provider Demographics
NPI:1831285899
Name:KENNEDY, MICHAEL CLARKSON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARKSON
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 1:7730 E MCDOWELL RD
Mailing Address - Street 2:SUITE # 107
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3772
Mailing Address - Country:US
Mailing Address - Phone:480-949-0600
Mailing Address - Fax:480-949-6670
Practice Address - Street 1:7730 E MCDOWELL RD
Practice Address - Street 2:SUITE # 107
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3772
Practice Address - Country:US
Practice Address - Phone:480-949-0600
Practice Address - Fax:480-949-6670
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor