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General NPI Number Information
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NPI Number | 1295133247
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Entity Type | Organization
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Legal Business Name | NEW YORK CHIROPRACTIC HEALTH PERFORMANCE, P.C.
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 54 MILLER RD STE 4
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City | MAHOPAC
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State | NY
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Zip | 10541-2223
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Country | US
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Telephone | 845-621-1739
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Fax | 845-621-2318
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Provider Business Mailing Address
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Address Line | 54 MILLER RD STE 4
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City | MAHOPAC
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State | NY
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Zip | 10541-2223
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Country | US
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Telephone | 845-621-1739
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Fax | 845-621-2318
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE INNES
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Credential | D.C.
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Telephone | 845-721-4358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012311-1
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License Number State | NY
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