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General NPI Number Information
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NPI Number | 1396845244
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Entity Type | Organization
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Legal Business Name | SKANEATELES SPINE & SPORT, INC.
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 7 FENNELL ST
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City | SKANEATELES
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State | NY
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Zip | 13152-1137
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Country | US
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Telephone | 315-685-1655
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Fax | 315-685-1657
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Provider Business Mailing Address
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Address Line | 1001 W FAYETTE ST SUITE 400
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City | SYRACUSE
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State | NY
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Zip | 13204-2859
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Country | US
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Telephone | 315-472-1488
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Fax | 315-476-1792
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Authorized Official
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Title or Position | OWNER
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Name | KIRBY JANKE
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Credential | PT, DC
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Telephone | 315-685-1655
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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