Provider Demographics
NPI:1730522095
Name:KENNEDY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KENNEDY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-400-4087
Mailing Address - Street 1:874 WHIPPLE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8901
Mailing Address - Country:US
Mailing Address - Phone:843-400-4087
Mailing Address - Fax:843-636-5689
Practice Address - Street 1:874 WHIPPLE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8901
Practice Address - Country:US
Practice Address - Phone:843-400-4087
Practice Address - Fax:843-636-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty