MEDICARE: DR. KENYON GODWIN 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	11576	TX

General Provider Information

NPI Number	:	1417266016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENYON GODWIN D.C.

Provider Business Mailing Address
First Line	:	4120 N COLLINS ST STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-4554
Country	:	US
Telephone Number	:	817-557-2770
Fax Number	:	817-557-1795

Provider Business Practice Location Address
First Line	:	4120 N COLLINS ST STE 200
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76005-4554
Country	:	US
Telephone Number	:	817-557-2770
Fax Number	:	817-557-1795

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	12/30/2024

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Directions to “ DR. KENYON GODWIN D.C.” Practice Location

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