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General NPI Number Information
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NPI Number | 1376877100
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Entity Type | Individual
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Provider Name | KENNETH MEDLEY D.C. RPH
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Gender | Male
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Dates
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Enumeration Date | 09/26/2009
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 120 E NEW YORK AVE STE D
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City | DELAND
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State | FL
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Zip | 32724-5527
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Country | US
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Telephone | 386-873-2990
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Fax | 386-873-2991
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Provider Business Mailing Address
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Address Line | 902 LAKE LINDLEY DR S
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City | DELAND
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State | FL
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Zip | 32724-2565
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CH9522
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS0021792
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License Number State | FL
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