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General NPI Number Information
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NPI Number | 1902129505
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Entity Type | Organization
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Legal Business Name | KENNY CHIROPRACTIC INC
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 185 FRONT ST STE 107
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City | DANVILLE
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State | CA
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Zip | 94526-3323
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Country | US
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Telephone | 925-838-9355
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Fax | 925-838-9359
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Provider Business Mailing Address
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Address Line | 185 FRONT ST STE 107
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City | DANVILLE
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State | CA
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Zip | 94526-3323
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Country | US
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Telephone | 925-838-9355
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Fax | 925-838-9359
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Authorized Official
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Title or Position | CEO
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Name | JERRY M KENNY
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Credential | DC
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Telephone | 925-838-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC25578
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License Number State | CA
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