Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 001677 | CT |
N | 111N00000X | Chiropractor | X011213-1 | NY |
N | 111NN1001X | Nutrition | 001677 | CT |
NPI | 1396783635 |
---|---|
Provider Name | Dr. Matthew C. Kenney |
First Address | Fairfield, CT 06824-5723 |
Second Address | Fairfield, CT 06824-5723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 20/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V09427 | (02) | CT |