Provider Demographics
NPI:1720272743
Name:KENNEALLY, JANICE AKN (DC)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:AKN
Last Name:KENNEALLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SUCCESS AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4571
Mailing Address - Country:US
Mailing Address - Phone:203-381-9119
Mailing Address - Fax:
Practice Address - Street 1:655 SUCCESS AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4571
Practice Address - Country:US
Practice Address - Phone:203-381-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor