Healthcare Provider Details

I. General information

NPI: 1033379573
Provider Name (Legal Business Name): KENNEDY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 W MAIN ST
SALEM VA
24153-3120
US

IV. Provider business mailing address

1461 W MAIN ST
SALEM VA
24153-3120
US

V. Phone/Fax

Practice location:
  • Phone: 540-375-9220
  • Fax: 540-375-9229
Mailing address:
  • Phone: 540-375-9220
  • Fax: 540-375-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104555747
License Number StateVA

VIII. Authorized Official

Name: DR. PATRICK DAVID KENNEDY
Title or Position: OWNER
Credential: DC
Phone: 540-375-9220