Provider Demographics
NPI:1588919286
Name:KENNEDY, SAMANTHA LOU (DC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LOU
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 EDGEWOOD RD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-4706
Mailing Address - Country:US
Mailing Address - Phone:319-294-4855
Mailing Address - Fax:
Practice Address - Street 1:5300 EDGEWOOD RD NE STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411-4706
Practice Address - Country:US
Practice Address - Phone:319-294-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor