Provider Demographics
NPI:1164265427
Name:KENNEDY, SARA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:NICOLE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:NICOLE
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 CITADEL WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1638
Mailing Address - Country:US
Mailing Address - Phone:702-469-0248
Mailing Address - Fax:
Practice Address - Street 1:530 CITADEL WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-1638
Practice Address - Country:US
Practice Address - Phone:702-469-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB02043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty