Provider Demographics
NPI:1902090756
Name:TALLEY, KENNETH MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:TALLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6617
Mailing Address - Country:US
Mailing Address - Phone:850-473-5555
Mailing Address - Fax:850-332-7647
Practice Address - Street 1:1449 W NINE MILE RD STE 5
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-5384
Practice Address - Country:US
Practice Address - Phone:850-473-5555
Practice Address - Fax:850-332-7647
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2218111N00000X
FLCH14051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor