Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 104556184 | VA |
N | 111NS0005X | Chiropractic Sports Physician | 104556184 | VA |
NPI | 1164429734 |
---|---|
Provider Name | Dr. Joseph S Kennedy |
First Address | Chesterfield, VA 23838-5158 |
Second Address | Chester, VA 23831-1425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 06/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
99222 | (02) | VA |