Provider Demographics
NPI:1780055517
Name:SHAWN P KENDRICK DC PLLC
Entity type:Organization
Organization Name:SHAWN P KENDRICK DC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-392-9807
Mailing Address - Street 1:1414 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2648
Mailing Address - Country:US
Mailing Address - Phone:434-392-9807
Mailing Address - Fax:434-392-7081
Practice Address - Street 1:1414 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2648
Practice Address - Country:US
Practice Address - Phone:434-392-9807
Practice Address - Fax:434-392-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty