MEDICARE: KERSTIN N MEDWIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X010877-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10088278	OTHER	NY	CDPHP
2	C10877-1B	OTHER	NY	WORKER'S COMPENSATION

General Provider Information

NPI Number	:	1134264120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERSTIN N MEDWIN D.C.

Provider Business Mailing Address
First Line	:	407 ALBANY SHAKER RD
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-1902
Country	:	US
Telephone Number	:	518-435-1280
Fax Number	:	518-435-1284

Provider Business Practice Location Address
First Line	:	407 ALBANY SHAKER RD
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-1902
Country	:	US
Telephone Number	:	518-435-1280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	03/22/2018

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