Provider Demographics
NPI:1124065123
Name:KENKEL, MIKE V (DC)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:V
Last Name:KENKEL
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 1:502 SHARP ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-1731
Mailing Address - Country:US
Mailing Address - Phone:712-527-5800
Mailing Address - Fax:712-527-2065
Practice Address - Street 1:502 SHARP ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1731
Practice Address - Country:US
Practice Address - Phone:712-527-5800
Practice Address - Fax:712-527-2065
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3264648Medicaid
IA3264648Medicaid
IAU992266Medicare UPIN