Healthcare Provider Details

I. General information

NPI: 1619090842
Provider Name (Legal Business Name): JOHN KENNEDY DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 HOOVER CT SUITE 101
HOOVER AL
35226-3606
US

IV. Provider business mailing address

1951 HOOVER CT SUITE 101
HOOVER AL
35226-3606
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-5692
  • Fax: 205-979-3697
Mailing address:
  • Phone: 205-979-5692
  • Fax: 205-979-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1795
License Number StateAL

VIII. Authorized Official

Name: DR. JOHN KENNEDY
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 205-979-5692