MEDICARE: DR. AMY L KENNEDY D.C.

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	111N00000X	Chiropractor	DC26747	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800040509	OTHER	CA	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1124159413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY L KENNEDY D.C.

Provider Business Mailing Address
First Line	:	28924 S WESTERN AVE
Second Line	:	SUITE 208
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0885
Country	:	US
Telephone Number	:	310-831-8833
Fax Number	:	310-831-8831

Provider Business Practice Location Address
First Line	:	28924 S WESTERN AVE
Second Line	:	SUITE 208
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0885
Country	:	US
Telephone Number	:	310-831-8833
Fax Number	:	310-831-8831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	03/14/2011

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