Organization
KENNEDY CHIROPRACTIC HEALTH CENTER
Active
Other names
ALLSPORTS PHYSICAL MEDICINE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIA M KENNEDY D.C. (OWNER)
(540) 483-3678
Entity
Organization
Contact information
Practice address
45 MARKETPLACE DR, SUITE 102, ROCKY MOUNT, VA 24151-6516
(540) 483-3678
(540) 483-3820
Mailing address
5858 SALISBURY DR, ROANOKE, VA 24018-4116
(540) 400-0036
(540) 483-3820
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
0104555747
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
182483
ANTHEM DRCOLLINS PROVIDER
VA
01
—
285308
ANTHEM GROUP NUMBER
VA
01
—
317684
ANTHEM PROVIDER NUMBER
VA
Enumeration date
01/16/2007
Last updated
08/22/2020
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