=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497178115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAITLYN CLARKE D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2014
-----------------------------------------------------
Last Update Date | 06/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 BUSINESS PARK DR
-----------------------------------------------------
City | ARMONK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10504-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-202-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 LOCUST HILL RD
-----------------------------------------------------
City | MAHOPAC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10541-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-222-9842
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 012467
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------