Provider Demographics
NPI:1760476642
Name:KENNEDY, JASON ATKINS (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ATKINS
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 W VA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2005
Mailing Address - Country:US
Mailing Address - Phone:757-623-7776
Mailing Address - Fax:757-623-1522
Practice Address - Street 1:909 HIOAKS RD
Practice Address - Street 2:STE. H
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4038
Practice Address - Country:US
Practice Address - Phone:804-565-9551
Practice Address - Fax:804-565-9552
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T21394Medicare UPIN