Provider Demographics
NPI:1730843806
Name:KENNEDY, NOLAN PATRICK (DC)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:PATRICK
Last Name:KENNEDY
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 1:923 BOSTON WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-3161
Mailing Address - Country:US
Mailing Address - Phone:563-543-9170
Mailing Address - Fax:
Practice Address - Street 1:5945 COUNCIL ST NE STE B
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5897
Practice Address - Country:US
Practice Address - Phone:319-409-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor