Provider Demographics
NPI:1982744579
Name:VANCE, KENNAN JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNAN
Middle Name:JOHN
Last Name:VANCE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2373 G RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9641
Mailing Address - Country:US
Mailing Address - Phone:970-245-0484
Mailing Address - Fax:970-214-1681
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9641
Practice Address - Country:US
Practice Address - Phone:970-245-0484
Practice Address - Fax:970-214-1681
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-09-23
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Provider Licenses
StateLicense IDTaxonomies
CO46879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery