Provider Demographics
NPI:1942337357
Name:KENNEDY, NATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
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 1:8105 PICARD LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4729
Mailing Address - Country:US
Mailing Address - Phone:703-403-5405
Mailing Address - Fax:
Practice Address - Street 1:8105 PICARD LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4729
Practice Address - Country:US
Practice Address - Phone:703-403-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03415111N00000X
VA0104556363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor