Active NPI
Kathleen M Favaloro, CHIROPRACTOR, PT
- Chiropractor
- Great Barrington, MA
National Provider Identifier
1023181708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2395
- Practice address
- 19 Lewis Avenue
Great Barrington, MA 01230 - Phone
- (413) 528-5535
- NPI assigned
- Nov 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2395 | MA | Primary |
| Chiropractor | 111N00000X | X009242-1 | NY | |
| Physical Therapist | 225100000X | 006800-1 | NY | |
| Physical Therapist | 225100000X | 12166 | MA |
Addresses
Primary practice location
19 Lewis Avenue
Great Barrington, MA 01230
Mailing address
PO Box 12
Great Barrington, MA 01230-0012
Phone (413) 528-5535
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q04313 | Other | DC BCBS | |
| Q04314 | Other | PT BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2395 | MA | MD | Chiropractor |
| X009242-1 | NY | MD | Chiropractor |
| 006800-1 | NY | MD | Physical Therapist |
| 12166 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439251200000",
"number": "1023181708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12",
"city": "GREAT BARRINGTON",
"state": "MA",
"postal_code": "012300012",
"telephone_number": "413-528-5535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 LEWIS AVENUE",
"city": "GREAT BARRINGTON",
"state": "MA",
"postal_code": "01230",
"telephone_number": "413-528-5535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVALORO",
"first_name": "KATHLEEN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "CHIROPRACTOR, PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2015-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MA",
"license": "2395",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "X009242-1",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "006800-1",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "12166",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DC BCBS",
"identifier": "Q04313",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT BCBS",
"identifier": "Q04314",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Barrington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.