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NPI Code Detail

MEDICARE: KIRSTEN J. FORMAN-BAILEY D.C.

MEDICARE: KIRSTEN J. FORMAN-BAILEY D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorX008568-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17653252OTHERNYAETNA
2106029ANOTHERNYPREFERRED CARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4P010008568OTHERNYBLUE CROSS
5RC70008568OTHERNYPOMCO

General Provider Information

NPI Number : 1457388274
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN J. FORMAN-BAILEY D.C.
Provider Business Mailing Address
First Line : 513 W UNION ST
Second Line :
City : NEWARK
State : NY
Zip : 14513-1365
Country : US
Telephone Number : 315-331-1801
Fax Number : 315-331-1802
Provider Business Practice Location Address
First Line : 513 W UNION ST
Second Line :
City : NEWARK
State : NY
Zip : 14513-1365
Country : US
Telephone Number : 315-331-1801
Fax Number : 315-331-1802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 09/27/2010

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