Kody S Kettle

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

01045557796 Issued in VA

Practice address

24805 Pinebrook Rd Ste 314
Chantilly, VA 20152-4128

Phone

(702) 957-3373

NPI assigned

Mar 2, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Healthcare Systems IncGroup PAC ID 2466735493, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Integrated Healthcare Systems Inc

  • Sports Physician Chiropractor
  • Chantilly, VA
  • NPI 1437693348
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1669129383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24805 PINEBROOK RD STE 314",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201524128",
            "telephone_number": "703-957-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24805 PINEBROOK RD STE 314",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201524128",
            "telephone_number": "702-957-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTLE",
        "first_name": "KODY",
        "middle_name": "S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-02",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "01045557796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Elias Keller, RN
• Joann Caryl Kelly, PH,D.
• Kathleen Kelly, LCSW
• Keough Senior Living LLC
• Sara Lucas Kepple, DO
• Key Life Home Care, LLC
• Rayan Tariq Khalid
• Kanwal S Khan, MD
• Mariam Nouman Khan
• Monsurul H Khan, MD

• Chiropractor in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.