Colleen Anne Kennedy, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

038004218 Issued in IL

Practice address

1141 55TH St
Downers Grove, IL 60515-4812

Phone

(630) 963-5029

Fax

(630) 297-8372

NPI assigned

Dec 18, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Chiropractic

Education

National College of Chiropractic, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697328000000",
    "number": "1982767299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 55TH ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605154812",
            "telephone_number": "630-963-5029",
            "fax_number": "630-297-8372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 55TH ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605154812",
            "telephone_number": "630-963-5029",
            "fax_number": "630-297-8372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "COLLEEN",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-10-15",
        "certification_date": "2023-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "IL",
            "license": "038004218",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038004218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "02215206",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS LICENSE  NUMBER",
            "identifier": "038004218",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2023; 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.