Healthcare Provider Details

I. General information

NPI: 1780763227
Provider Name (Legal Business Name): KENNETH S SOLOMON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 ROUTE 55 STE 5
LAGRANGEVILLE NY
12540-5047
US

IV. Provider business mailing address

1145 ROUTE 55 STE 5
LAGRANGEVILLE NY
12540-5047
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-6620
  • Fax: 845-473-5116
Mailing address:
  • Phone: 845-473-6620
  • Fax: 845-473-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX00002695
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: