Organization Active NPI

Advantage Chiropractic, PLLC

  • Chiropractor
  • Cedar Rapids, IA
National Provider Identifier
1053060558
Registry record updated Mar 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
ADVANTAGE CHIROPRACTIC, PLLC
Practice address
5945 Council St NE Ste B
Cedar Rapids, IA 52402-5897
Phone
(319) 409-5941
Fax
(319) 409-5942
NPI assigned
Mar 22, 2022
Last updated
Mar 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2022

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

Authorized official

Name
Dr. Nolan Kennedy, DCNPI 1730843806
Title
Owner
Phone
(319) 409-5941

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

5945 Council St NE Ste B
Cedar Rapids, IA 52402-5897

Mailing address

5945 Council St NE Ste B
Cedar Rapids, IA 52402-5897
Phone (319) 409-5941

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220321002731 IA Part B Supplier - Clinic/Group Practice 3274928627 Receives reassigned benefits from 2 practitioners
Practice locations: Cedar Rapids, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2257920Advantage Chiropractic5945 Council St NE, Ste B, Cedar Rapids, IA 52402Certificate of waiverApr 12, 2028

National Provider Directory

National Provider Directory

Locations

5945 Council St NE
Ste B
Cedar Rapids, IA 52402
Phone (319) 373-5082

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1053060558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5945 COUNCIL ST NE STE B",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524025897",
            "telephone_number": "319-409-5941",
            "fax_number": "319-409-5942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5945 COUNCIL ST NE STE B",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524025897",
            "telephone_number": "319-409-5941",
            "fax_number": "319-409-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "NOLAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-409-5941",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.