MEDICARE: KEITH BRIAN DUVERNEY

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	006621	GA
2	111N00000X	Chiropractor	7130	TX
3	111N00000X	Chiropractor	X011776-1	NY

General Provider Information

NPI Number	:	1447350970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH BRIAN DUVERNEY

Provider Business Mailing Address
First Line	:	126 WASHINGTON PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-6819
Country	:	US
Telephone Number	:	212-675-6662
Fax Number	:	212-675-6673

Provider Business Practice Location Address
First Line	:	126 WASHINGTON PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-6819
Country	:	US
Telephone Number	:	212-675-6662
Fax Number	:	212-675-6673

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	06/18/2010

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