Provider Demographics
NPI:1912045121
Name:GONOUD, KENNETH P (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:P
Last Name:GONOUD
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 1:4191 EAST TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:715-409-4086
Mailing Address - Fax:718-892-3398
Practice Address - Street 1:4191 EAST TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:718-409-4086
Practice Address - Fax:718-892-3398
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX44531111N00000X
NYX005767-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX44531Medicare ID - Type Unspecified
U06493Medicare UPIN