Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 128-0655-0184A | NH |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 565 | CT |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 896288 | MA |
NPI | 1720091994 |
---|---|
Provider Name | Dr. Leo Michael Kenney |
First Address | North Conway, NH 03860-0003 |
Second Address | North Conway, NH 03860-5189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0506455Y0NH01 | ANTHEM BLUE CROSS (01) | NH |
9000306 | CIGNA (01) | NH |
T86224 | (02) | NH |
T86224 | HARVARD PILGRIM (01) | NH |