Provider Demographics
NPI:1902695729
Name:KENNEBECK, WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:KENNEBECK
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 ROLLING BROOK RD APT 305-10
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-1447
Mailing Address - Country:US
Mailing Address - Phone:402-838-9423
Mailing Address - Fax:
Practice Address - Street 1:2522 COLONIAL AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3121
Practice Address - Country:US
Practice Address - Phone:540-929-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104558087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor