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General NPI Number Information
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NPI Number | 1518141027
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Entity Type | Organization
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Legal Business Name | MICHAEL J KENNEDY D.C., P.A.
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 6409 CITY WEST PARKWAY SUITE 105
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344
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Country | US
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Telephone | 952-833-3038
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Fax |
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Provider Business Mailing Address
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Address Line | 12105 41ST AVE NORTH APT 118
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 612-387-5864
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/VICE-PRESIDENT/TREASURER
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Name | DR. MICHAEL JOHN KENNEDY
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Credential | D.C.
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Telephone | 612-387-5864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4999
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License Number State | MN
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