Active NPI
Kenneth W Padgett, DC
- Chiropractor
- Waterloo, NY
National Provider Identifier
1558393603
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- X0002701
- Practice address
- 2374 Mound Rd Rte 414
Waterloo, NY 13165 - Phone
- (315) 539-3262
- Fax
- (315) 539-5221
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | X0002701 | NY | Primary |
Addresses
Primary practice location
2374 Mound Rd Rte 414
Waterloo, NY 13165
Mailing address
PO Box 664
Waterloo, NY 13165
Phone (315) 539-3262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50057 | Other | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X0002701 | NY | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197331200000",
"number": "1558393603",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 664",
"city": "WATERLOO",
"state": "NY",
"postal_code": "13165",
"telephone_number": "315-539-3262",
"fax_number": "315-539-5221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2374 MOUND RD RTE 414",
"city": "WATERLOO",
"state": "NY",
"postal_code": "13165",
"telephone_number": "315-539-3262",
"fax_number": "315-539-5221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PADGETT",
"first_name": "KENNETH",
"middle_name": "W",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "X0002701",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "50057",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.