Provider Demographics
NPI:1942343694
Name:KENNEY, JEFFREY THOMAS (LAC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:KENNEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 CARAWAY ST
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1211
Mailing Address - Country:US
Mailing Address - Phone:301-320-0740
Mailing Address - Fax:
Practice Address - Street 1:5225 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 601
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2014
Practice Address - Country:US
Practice Address - Phone:202-364-6016
Practice Address - Fax:202-237-2583
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist