Provider Demographics
NPI:1922093780
Name:KENNEDY, CORINNE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ANN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CORINNE
Other - Middle Name:ANN
Other - Last Name:KENNEDY BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5422 N LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3006
Mailing Address - Country:US
Mailing Address - Phone:414-438-9206
Mailing Address - Fax:414-438-9208
Practice Address - Street 1:5422 N LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3006
Practice Address - Country:US
Practice Address - Phone:414-438-9206
Practice Address - Fax:414-438-9208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38851000Medicaid
U06766Medicare UPIN