Healthcare Provider Details

I. General information

NPI: 1831285899
Provider Name (Legal Business Name): MICHAEL CLARKSON KENNEDY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 E MCDOWELL RD SUITE # 107
SCOTTSDALE AZ
85257-3772
US

IV. Provider business mailing address

7730 E MCDOWELL RD SUITE # 107
SCOTTSDALE AZ
85257-3772
US

V. Phone/Fax

Practice location:
  • Phone: 480-949-0600
  • Fax: 480-949-6670
Mailing address:
  • Phone: 480-949-0600
  • Fax: 480-949-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: