Provider Demographics
NPI:1992805063
Name:KENNARD, ROSS YEAGER (DC)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:YEAGER
Last Name:KENNARD
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 1:650 RITCHIE HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3916
Mailing Address - Country:US
Mailing Address - Phone:410-421-5544
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3916
Practice Address - Country:US
Practice Address - Phone:410-421-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU88300Medicare UPIN