Healthcare Provider Details

I. General information

NPI: 1700867173
Provider Name (Legal Business Name): KARYN MARIA DORNEMANN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHERMAN POTTS DR
GHENT NY
12075-3216
US

IV. Provider business mailing address

2 SHERMAN POTTS DR
GHENT NY
12075-3216
US

V. Phone/Fax

Practice location:
  • Phone: 518-828-2133
  • Fax: 518-822-1537
Mailing address:
  • Phone: 518-828-2133
  • Fax: 518-822-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005279-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: