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General NPI Number Information
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NPI Number | 1982257150
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Entity Type | Individual
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Provider Name | SUSAN KENNEDY DC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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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 | 773-357-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 921 MARYKNOLL CIR
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City | GLEN ELLYN
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State | IL
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Zip | 60137-6139
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Country | US
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Telephone | 773-405-6411
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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 | 038.013398
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License Number State | IL
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