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General NPI Number Information
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NPI Number | 1033379573
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Entity Type | Organization
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Legal Business Name | KENNEDY CHIROPRACTIC INC.
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 1461 W MAIN ST
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City | SALEM
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State | VA
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Zip | 24153-3120
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Country | US
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Telephone | 540-375-9220
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Fax | 540-375-9229
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Provider Business Mailing Address
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Address Line | 1461 W MAIN ST
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City | SALEM
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State | VA
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Zip | 24153-3120
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Country | US
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Telephone | 540-375-9220
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Fax | 540-375-9229
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK DAVID KENNEDY
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Credential | DC
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Telephone | 540-375-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 0104555747
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License Number State | VA
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