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NPI Code Detail

MEDICARE: DR. WILLIAM KENNEBECK DC

MEDICARE: DR. WILLIAM KENNEBECK DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor0104558087VA

General Provider Information

NPI Number : 1902695729
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM KENNEBECK DC
Provider Business Mailing Address
First Line : 6521 ROLLING BROOK RD APT 305-10
Second Line :
City : ROANOKE
State : VA
Zip : 24019-1447
Country : US
Telephone Number : 402-838-9423
Fax Number :
Provider Business Practice Location Address
First Line : 2522 COLONIAL AVE SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-3121
Country : US
Telephone Number : 540-929-1617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2025
Last Update Date : 05/06/2025

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