Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | X003992-1 | NY |
NPI | 1316250475 |
---|---|
Provider Name | Mr. Kenneth Jameson |
First Address | Brooklyn, NY 11231-3403 |
Second Address | Richmond Hill, NY 11418-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 19/07/2010 |