Provider Demographics
NPI:1801494950
Name:ADVANCED CHIROPRACTIC & SPORTS REHABILITATION
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-875-3993
Mailing Address - Street 1:23548 BELVOIR WOODS TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7493
Mailing Address - Country:US
Mailing Address - Phone:631-875-3993
Mailing Address - Fax:
Practice Address - Street 1:22611 MARKEY CT STE 105
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6925
Practice Address - Country:US
Practice Address - Phone:631-875-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty