Active NPI
Mary Jane Kennel, LMT
- Specialist
- Corvallis, OR
National Provider Identifier
1881820553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 5919
- Practice address
- 990 NW Circle Blvd Ste 201
Corvallis, OR 97330-1410 - Phone
- (541) 768-6412
- NPI assigned
- Jun 8, 2009
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 5919 | OR | Primary |
Addresses
Primary practice location
990 NW Circle Blvd Ste 201
Corvallis, OR 97330-1410
Mailing address
990 NW Circle Blvd Ste 201
Corvallis, OR 97330-1410
Phone (541) 768-6412
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5919 | Other | OR | OREGON STATE LICENSE |
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 |
|---|---|---|---|
| 5919 | OR | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1244419200000",
"number": "1881820553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "990 NW CIRCLE BLVD STE 201",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973301410",
"telephone_number": "541-768-6412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 NW CIRCLE BLVD STE 201",
"city": "CORVALLIS",
"state": "OR",
"postal_code": "973301410",
"telephone_number": "541-768-6412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEL",
"first_name": "MARY JANE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-08",
"last_updated": "2009-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "5919",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OREGON STATE LICENSE",
"identifier": "5919",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corvallis, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.