Provider Demographics
NPI:1538531587
Name:KENYON, DOUGLAS G (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:G
Last Name:KENYON
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:PO BOX 771773
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-1773
Mailing Address - Country:US
Mailing Address - Phone:979-846-3265
Mailing Address - Fax:
Practice Address - Street 1:2851 RIVERSIDE PLZ UNIT 210A
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5224
Practice Address - Country:US
Practice Address - Phone:970-846-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor