MEDICARE: DR. LEO MICHAEL KENNEY 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	111NX0800X	Orthopedic Chiropractor	128-0655-0184A	NH
2	111NX0800X	Orthopedic Chiropractor	565	CT
3	111NX0800X	Orthopedic Chiropractor	896288	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0506455Y0NH01	OTHER	NH	ANTHEM BLUE CROSS
2	T86224	OTHER	NH	HARVARD PILGRIM
3	9000306	OTHER	NH	CIGNA

General Provider Information

NPI Number	:	1720091994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO MICHAEL KENNEY D.C.

Provider Business Mailing Address
First Line	:	PO BOX 3
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-0003
Country	:	US
Telephone Number	:	603-356-2471
Fax Number	:	603-356-8759

Provider Business Practice Location Address
First Line	:	3316 WHITE MOUNTAIN HIGHWAY
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5189
Country	:	US
Telephone Number	:	603-356-2471
Fax Number	:	603-356-8759

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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