MEDICARE: ROBERT MARK KENNEDY CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	DC18477	CA

General Provider Information

NPI Number	:	1093838591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT MARK KENNEDY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	11022 WINNERS CIR STE 107
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2883
Country	:	US
Telephone Number	:	562-430-8501
Fax Number	:

Provider Business Practice Location Address
First Line	:	6557 E PACIFIC COAST HWY # H-10
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4202
Country	:	US
Telephone Number	:	562-430-8501
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT M KENNEDY
Credential	:
Telephone Number	:	562-430-8501

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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