Provider Demographics
NPI:1740300870
Name:DUCEY-CLARK, KENNA S (DC, PC)
Entity type:Individual
Prefix:DR
First Name:KENNA
Middle Name:S
Last Name:DUCEY-CLARK
Suffix:
Gender:F
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5572
Mailing Address - Country:US
Mailing Address - Phone:303-320-1993
Mailing Address - Fax:303-320-4599
Practice Address - Street 1:248 S GARFIELD ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3120
Practice Address - Country:US
Practice Address - Phone:303-810-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5033111N00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No111N00000XChiropractic ProvidersChiropractor