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General NPI Number Information
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NPI Number | 1013565902
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Entity Type | Organization
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Legal Business Name | KENNEDY FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 1220 W OGDEN AVE STE D
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City | NAPERVILLE
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State | IL
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Zip | 60563-3977
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Country | US
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Telephone | 630-384-9305
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Fax |
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Provider Business Mailing Address
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Address Line | 222 W ROOSEVELT RD
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City | WHEATON
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State | IL
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Zip | 60187-5246
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Country | US
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Telephone | 630-384-9305
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Fax | 630-384-9305
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SUSAN KENNEDY
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Credential | DC
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Telephone | 773-357-6411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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