Provider Demographics
NPI:1982257150
Name:KENNEDY, SUSAN (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KENNEDY
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 1:921 MARYKNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6139
Mailing Address - Country:US
Mailing Address - Phone:773-405-6411
Mailing Address - Fax:
Practice Address - Street 1:1220 W OGDEN AVE STE D
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3977
Practice Address - Country:US
Practice Address - Phone:773-357-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor