Provider Demographics
NPI:1659240588
Name:ODOOM, KENNETH (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:ODOOM
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 1:14860 LYNHODGE CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1862
Mailing Address - Country:US
Mailing Address - Phone:703-437-8195
Mailing Address - Fax:703-437-2404
Practice Address - Street 1:1886 METRO CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5289
Practice Address - Country:US
Practice Address - Phone:703-437-8195
Practice Address - Fax:703-437-2404
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104558117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor