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General NPI Number Information
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NPI Number | 1437119062
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Entity Type | Individual
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Provider Name | KIM STUART VAN DER VEER DC, CCSP
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1134 TROY SCHENECTADY RD
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City | LATHAM
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State | NY
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Zip | 12110-1006
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Country | US
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Telephone | 518-783-1908
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Fax | 518-783-1909
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Provider Business Mailing Address
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Address Line | 1134 TROY SCHENECTADY RD
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City | LATHAM
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State | NY
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Zip | 12110-1006
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Country | US
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Telephone | 518-783-1908
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Fax | 518-783-1909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | X005017
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License Number State | NY
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