MEDICARE: DEREK MICHAEL KENNEY DC

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	008868	AZ

General Provider Information

NPI Number	:	1346192390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK MICHAEL KENNEY DC

Provider Business Mailing Address
First Line	:	6638 E FOUNTAIN ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-5700
Country	:	US
Telephone Number	:	623-216-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	6638 E FOUNTAIN ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-5700
Country	:	US
Telephone Number	:	623-216-6794
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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