Individual provider Active NPI

Patrick D Kennedy, DC

  • Chiropractor
  • Salem, VA
National Provider Identifier
1043389828
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104001882 Issued in VA
Practice address
1461 W Main St
Salem, VA 24153-3120
Phone
(540) 375-9220
Fax
(540) 375-9229
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104001882 VA Primary

Addresses

Primary practice location

1461 W Main St
Salem, VA 24153-3120

Mailing address

1461 W Main St
Salem, VA 24153-3120
Phone (540) 375-9220

Other identifiers 1

IdentifierTypeStateIssuer
350665OtherVAANTHEM PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080813000141 VA Practitioner - Chiropractic 9234204116 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Balance Wellspace Integrative Medicine, Inc. CurrentSince Jul 21, 2024 Accepting new patients
Tuck Chiropractic Corporation Chiropractor Past Accepting new patients
Kennedy Chiropractic Inc. PastSince Jul 21, 2008 Accepting new patients
Becker Clinic LTD Chiropractor Past Accepting new patients

Locations

2725 Market St
Christiansburg, VA 24073
Phone (540) 343-0055

2522 Colonial Ave SW
Roanoke, VA 24015
Phone (540) 343-0055

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1043389828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1461 W MAIN ST",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241533120",
            "telephone_number": "540-375-9220",
            "fax_number": "540-375-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 W MAIN ST",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "241533120",
            "telephone_number": "540-375-9220",
            "fax_number": "540-375-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PATRICK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104001882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "350665",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.