Active NPI
Shannon Eileen Kennedy, DC
- Chiropractor
- Phoenix, AZ
National Provider Identifier
1871128090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 8957
- Practice address
- 16515 S 40TH St Ste 133
Phoenix, AZ 85048-0560 - Phone
- (480) 704-6133
- Fax
- (480) 704-5874
- NPI assigned
- Mar 9, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 8957 | AZ | Primary |
Addresses
Primary practice location
16515 S 40TH St Ste 133
Phoenix, AZ 85048-0560
Mailing address
16515 S 40TH St Ste 133
Phoenix, AZ 85048-0560
Phone (480) 704-6133
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8957 | AZ | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sports & Fam Care Clinic Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Sports Physician Chiropractor
- Phoenix, AZ
- NPI 1316135551
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732060800000",
"number": "1871128090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16515 S 40TH ST STE 133",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850480560",
"telephone_number": "480-704-6133",
"fax_number": "480-704-5874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16515 S 40TH ST STE 133",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850480560",
"telephone_number": "480-704-6133",
"fax_number": "480-704-5874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "SHANNON",
"middle_name": "EILEEN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-09",
"last_updated": "2024-11-20",
"certification_date": "2024-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AZ",
"license": "8957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.