Provider Demographics
NPI:1538167093
Name:KENNY, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KENNY
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 1:15 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1269
Mailing Address - Country:US
Mailing Address - Phone:215-332-4770
Mailing Address - Fax:215-332-5057
Practice Address - Street 1:7439 FRANKFORD AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3600
Practice Address - Country:US
Practice Address - Phone:215-332-4770
Practice Address - Fax:215-332-5057
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003850L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08281Medicare UPIN
PA549234Medicare ID - Type Unspecified