Healthcare Provider Details

I. General information

NPI: 1487105847
Provider Name (Legal Business Name): KGS CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAMARONECK AVE SUITE 105
WHITE PLAINS NY
10605-1315
US

IV. Provider business mailing address

235 MAMARONECK AVENUE SUITE 105
WHITE PLAINS NY
10605
US

V. Phone/Fax

Practice location:
  • Phone: 914-686-8844
  • Fax: 914-686-8842
Mailing address:
  • Phone: 914-686-8844
  • Fax: 914-686-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberXO113122
License Number StateNY

VIII. Authorized Official

Name: DR. KONSTANTINOS SOFOS
Title or Position: OWNER
Credential: CHIROPRACTIC
Phone: 914-686-8844