MEDICARE: DR. CORINNE ANN KENNEDY 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	2590	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922093780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORINNE ANN KENNEDY DC

Provider Business Mailing Address
First Line	:	5422 N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	414-438-9206
Fax Number	:	414-438-9208

Provider Business Practice Location Address
First Line	:	5422 N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	414-438-9206
Fax Number	:	414-438-9208

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/08/2007

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