Provider Demographics
NPI:1871128090
Name:KENNEDY, SHANNON EILEEN (DC)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:EILEEN
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 1:16515 S 40TH ST STE 133
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0560
Mailing Address - Country:US
Mailing Address - Phone:480-704-6133
Mailing Address - Fax:480-704-5874
Practice Address - Street 1:16515 S 40TH ST STE 133
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0560
Practice Address - Country:US
Practice Address - Phone:480-704-6133
Practice Address - Fax:480-704-5874
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor