Healthcare Provider Details

I. General information

NPI: 1043429822
Provider Name (Legal Business Name): MICHAEL KENNEDY, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/23/2008
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 Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1096
License Number StateAZ

VIII. Authorized Official

Name: MICHAEL CLARKSON KENNEDY
Title or Position: OWNER
Credential: D.C.
Phone: 480-949-0600