Healthcare Provider Details

I. General information

NPI: 1801289855
Provider Name (Legal Business Name): MOUNT KISCO MEDICAL & INJURY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S BEDFORD RD STE. 109
MOUNT KISCO NY
10549-3440
US

IV. Provider business mailing address

103 S BEDFORD RD STE. 109
MOUNT KISCO NY
10549-3440
US

V. Phone/Fax

Practice location:
  • Phone: 914-523-2878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS CAMPBELL
Title or Position: OWNER
Credential: D.C.
Phone: 845-331-0457