Healthcare Provider Details

I. General information

NPI: 1720091994
Provider Name (Legal Business Name): LEO MICHAEL KENNEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 WHITE MOUNTAIN HIGHWAY
NORTH CONWAY NH
03860-5189
US

IV. Provider business mailing address

PO BOX 3
NORTH CONWAY NH
03860-0003
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-2471
  • Fax: 603-356-8759
Mailing address:
  • Phone: 603-356-2471
  • Fax: 603-356-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number128-0655-0184A
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number565
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number896288
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: