=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578541686
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORY LYN KENYON D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2006
-----------------------------------------------------
Last Update Date | 10/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 MADISON ST
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37160-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-842-9995
-----------------------------------------------------
Fax | 931-263-8748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 131
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37162-0131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-842-9995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3879DC
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2344
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------