| Michael J Kennedy D.c., P.a. | |
|
6409 City West Parkway Suite 105 Eden Prairie MN 55344 | |
| (952) 833-3038 | |
| Not Available |
| Full Name | Michael J Kennedy D.c., P.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 6409 City West Parkway, Eden Prairie, Minnesota |
| Authorized Official Name and Position | Michael John Kennedy (PRESIDENT/VICE-PRESIDENT/TREASURER) |
| Authorized Official Contact | 6123875864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael J Kennedy D.c., P.a. 12105 41st Ave North Apt 118 Plymouth MN 55441 Ph: (612) 387-5864 | Michael J Kennedy D.c., P.a. 6409 City West Parkway Suite 105 Eden Prairie MN 55344 Ph: (952) 833-3038 |
| NPI Number | 1518141027 |
|---|---|
| Provider Enumeration Date | 12/19/2007 |
| Last Update Date | 12/19/2007 |
| Medicare PECOS PAC ID | 6507943099 |
|---|---|
| Medicare Enrollment ID | O20080408000688 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518141027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 4999 (Minnesota) | Primary |
| Provider Name | Michael J Kennedy |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1639358088 PECOS PAC ID: 9739266222 Enrollment ID: I20080408000654 |
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