Individual
MRS. MIA M KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1461 W MAIN ST, SALEM, VA 24153-3120
(540) 375-9220
(540) 375-9229
Mailing address
1461 W MAIN ST, SALEM, VA 24153-3120
(540) 375-9220
(540) 375-9229
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104555747
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350669
ANTHEM PROVIDER NUMBER
VA
Enumeration date
11/07/2006
Last updated
09/23/2008
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