MEDICARE: DR. SCOTT JOSEPH KENNY 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	038-076110	IL

General Provider Information

NPI Number	:	1679578348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT JOSEPH KENNY DC

Provider Business Mailing Address
First Line	:	2499 E JOLIET HWY
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-2592
Country	:	US
Telephone Number	:	815-717-8355
Fax Number	:	815-717-8416

Provider Business Practice Location Address
First Line	:	2499 E JOLIET HWY
Second Line	:
City	:	NEW LENOX
State	:	IL
Zip	:	60451-2592
Country	:	US
Telephone Number	:	815-717-8355
Fax Number	:	815-717-8416

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/28/2022

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