Provider Demographics
NPI:1124317706
Name:KENNELL FAMILY CHIROPRACTIC PA
Entity type:Organization
Organization Name:KENNELL FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:KENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:830-249-8900
Mailing Address - Street 1:215 W BANDERA RD STE 114
Mailing Address - Street 2:PMB 406
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2842
Mailing Address - Country:US
Mailing Address - Phone:830-249-8900
Mailing Address - Fax:830-249-8923
Practice Address - Street 1:115 HWY 46 WEST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2842
Practice Address - Country:US
Practice Address - Phone:830-249-8900
Practice Address - Fax:830-249-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX 8054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB133288Medicare PIN
TXU72264Medicare UPIN