Provider Demographics
NPI:1215187638
Name:DR. KENNA DUCEY-CLARK D.C.,P.C.
Entity type:Organization
Organization Name:DR. KENNA DUCEY-CLARK D.C.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUCEY-CLARK D.C,P.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-320-1993
Mailing Address - Street 1:300 S JACKSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3131
Mailing Address - Country:US
Mailing Address - Phone:303-320-1993
Mailing Address - Fax:303-320-4599
Practice Address - Street 1:300 S JACKSON ST STE 105
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3131
Practice Address - Country:US
Practice Address - Phone:303-320-1993
Practice Address - Fax:303-320-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty