Healthcare Provider Details

I. General information

NPI: 1730395005
Provider Name (Legal Business Name): JOHN PATRICK KENNEDY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 W PEACHTREE ST NW SUITE 130
ATLANTA GA
30309-3445
US

IV. Provider business mailing address

1280 W PEACHTREE ST NW SUITE 130
ATLANTA GA
30309-3445
US

V. Phone/Fax

Practice location:
  • Phone: 404-876-4001
  • Fax: 404-875-3845
Mailing address:
  • Phone: 404-876-4001
  • Fax: 404-875-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR002797
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: