Peter Shaun Kavanaugh, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1897 Issued in PA

Practice address

3301 Ryan Ave
Philadelphia, PA 19136-4301

Phone

(215) 332-8686

Fax

(215) 332-8691

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. P Shaun Kavanaugh Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Marini Chiropractic & Education PC

  • Clinic/Center
  • King of Prussia, PA
  • NPI 1356478572
  NPD (past)
• Mayfair Family Chiropractic Center Inc.

  • Chiropractor
  • Philadelphia, PA
  • NPI 1770149452
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328572800000",
    "number": "1154484111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 RYAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19136",
            "telephone_number": "215-332-8686",
            "fax_number": "215-332-8691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 RYAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191364301",
            "telephone_number": "215-332-8686",
            "fax_number": "215-332-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVANAUGH",
        "first_name": "PETER",
        "middle_name": "SHAUN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2012-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "1897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "0061018000",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087374",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "2142140000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "P",
            "last_name": "KAVANAUGH",
            "middle_name": "SHAUN",
            "prefix": "DR.",
            "credential": "DC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Rashika Kaushik, CRNP
• Maryan Kauta, PT, DPT
• Marin Michelle Kautz, PH.D.
• Niyatha Kaval, DMD
• Rachel Kavanagh
• William Nathan Kavesh, M.D.
• Mani S Kavuru, MD
• Taiki Kawaida
• Masashi Kawamura
• Mary B. Kawan, MD

• Chiropractor in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.