Provider Demographics
NPI:1720091994
Name:KENNEY, LEO MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:MICHAEL
Last Name:KENNEY
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-0003
Mailing Address - Country:US
Mailing Address - Phone:603-356-2471
Mailing Address - Fax:603-356-8759
Practice Address - Street 1:3316 WHITE MOUNTAIN HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5189
Practice Address - Country:US
Practice Address - Phone:603-356-2471
Practice Address - Fax:603-356-8759
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH128-0655-0184A111NX0800X
CT565111NX0800X
MA896288111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0506455Y0NH01OtherANTHEM BLUE CROSS
NHT86224OtherHARVARD PILGRIM
NH9000306OtherCIGNA
NH0506455Y0NH01OtherANTHEM BLUE CROSS
NH9000306OtherCIGNA
NHKENH8434Medicare ID - Type Unspecified