Healthcare Provider Details

I. General information

NPI: 1114064516
Provider Name (Legal Business Name): PATENAUDE CHIROPRACTIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 HUDSON AVE
STILLWATER NY
12170-0427
US

IV. Provider business mailing address

PO BOX 427
STILLWATER NY
12170-0427
US

V. Phone/Fax

Practice location:
  • Phone: 518-664-4525
  • Fax: 518-664-1256
Mailing address:
  • Phone: 518-664-4525
  • Fax: 518-664-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011154
License Number StateNY

VIII. Authorized Official

Name: DR. KELLI LEIGH PATENAUDE
Title or Position: CHIROPRACTOR PARTNER
Credential: DC
Phone: 518-664-4525