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General NPI Number Information
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NPI Number | 1659240588
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Entity Type | Individual
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Provider Name | KENNETH ODOOM DC
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Gender | Male
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 1886 METRO CENTER DR STE 100
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City | RESTON
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State | VA
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Zip | 20190-5289
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Country | US
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Telephone | 703-437-8195
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Fax | 703-437-2404
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Provider Business Mailing Address
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Address Line | 14860 LYNHODGE CT
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City | CENTREVILLE
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State | VA
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Zip | 20120-1862
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Country | US
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Telephone | 703-437-8195
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Fax | 703-437-2404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104558117
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License Number State | VA
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