Organization
KENNEDY CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D KENNEDY PC (OWNER)
(503) 635-4558
Entity
Organization
Contact information
Practice address
155 B AVE, SUITE 120, LAKE OSWEGO, OR 97034-3148
(503) 635-4558
Mailing address
155 B AVE, SUITE 120, LAKE OSWEGO, OR 97034-3148
(503) 635-4558
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1536
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285734335
INDIVIDUAL NPI NUMBER
OR
Enumeration date
04/02/2007
Last updated
08/22/2020
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