Provider Demographics
NPI:1841482676
Name:KENNEDY, JASON BRENT (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:BRENT
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 1:9810 LAKE FOREST BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127
Mailing Address - Country:US
Mailing Address - Phone:504-242-4221
Mailing Address - Fax:
Practice Address - Street 1:9810 LAKE FOREST BLVD
Practice Address - Street 2:STE 101
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127
Practice Address - Country:US
Practice Address - Phone:504-242-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor