Provider Demographics
NPI:1164429734
Name:KENNEDY, JOSEPH S (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11148 STERLING COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5158
Mailing Address - Country:US
Mailing Address - Phone:804-305-5748
Mailing Address - Fax:
Practice Address - Street 1:10330 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1425
Practice Address - Country:US
Practice Address - Phone:804-748-5748
Practice Address - Fax:804-523-8013
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104556184111NS0005X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014392C60Medicare PIN
VA99222Medicare UPIN