Provider Demographics
NPI:1780902387
Name:ROBERT C KENNY DC PC
Entity type:Organization
Organization Name:ROBERT C KENNY DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-238-6951
Mailing Address - Street 1:7970 M 68
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9041
Mailing Address - Country:US
Mailing Address - Phone:231-238-6951
Mailing Address - Fax:231-238-0197
Practice Address - Street 1:7970 M 68
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9041
Practice Address - Country:US
Practice Address - Phone:231-238-6951
Practice Address - Fax:231-238-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty