Healthcare Provider Details

I. General information

NPI: 1184638538
Provider Name (Legal Business Name): KEITH LEWIN HOSMER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 CAZENOVIA STREET
BUFFALO NY
14210
US

IV. Provider business mailing address

154 CAZENOVIA STREET
BUFFALO NY
14210
US

V. Phone/Fax

Practice location:
  • Phone: 716-824-5548
  • Fax: 716-824-5549
Mailing address:
  • Phone: 716-824-5548
  • Fax: 716-824-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0083201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: