NPIMap

Organization Active NPI

Chiro-Med & Rehab

  • Orthopedic Physical Therapist
  • Bennington, VT
National Provider Identifier
1124384938
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
006.0061495 Issued in VT
Legal business name
CHIRO-MED & REHAB
Practice address
345 Elm St
Bennington, VT 05201-2265
Phone
(802) 753-7930
Fax
(802) 753-7924
NPI assigned
Apr 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Authorized official

Name
Dr. Kenneth James Sullivan-Bol, DCNPI 1679529788
Title
President/ Ceo
Phone
(802) 753-7930

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 006.0061495 VT
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 38-009348 IL
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X 006.0061495 VT Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

345 Elm St
Bennington, VT 05201-2265

Mailing address

345 Elm St
Bennington, VT 05201-2265
Phone (802) 753-7930

Other identifiers 1

IdentifierTypeStateIssuer
1020447MedicaidVT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120607000362 VT Part B Supplier - Clinic/Group Practice 3870757610 Receives reassigned benefits from 3 practitioners
Practice locations: Bennington, VT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1124384938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 ELM ST",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052012265",
            "telephone_number": "802-753-7930",
            "fax_number": "802-753-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 ELM ST",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052012265",
            "telephone_number": "802-753-7930",
            "fax_number": "802-753-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRO-MED & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN-BOL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "802-753-7930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VT",
            "license": "006.0061495",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "38-009348",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "VT",
            "license": "006.0061495",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020447",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; 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.