Healthcare Provider Details

I. General information

NPI: 1780902387
Provider Name (Legal Business Name): ROBERT C KENNY DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7970 M 68
INDIAN RIVER MI
49749-9041
US

IV. Provider business mailing address

7970 M 68
INDIAN RIVER MI
49749-9041
US

V. Phone/Fax

Practice location:
  • Phone: 231-238-6951
  • Fax: 231-238-0197
Mailing address:
  • Phone: 231-238-6951
  • Fax: 231-238-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1961
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT CLAIRE KENNY
Title or Position: OWNER
Credential: DC
Phone: 231-238-6951