MEDICARE: DR. KERRY DEYO 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	012900	NY

General Provider Information

NPI Number	:	1619411196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY DEYO D.C.

Provider Business Mailing Address
First Line	:	14 COLUMBIA CIR
Second Line	:	STE 203
City	:	ALBANY
State	:	NY
Zip	:	12203-5163
Country	:	US
Telephone Number	:	518-512-9626
Fax Number	:	518-931-4020

Provider Business Practice Location Address
First Line	:	14 COLUMBIA CIR
Second Line	:	STE 203
City	:	ALBANY
State	:	NY
Zip	:	12203-5163
Country	:	US
Telephone Number	:	518-512-9626
Fax Number	:	518-931-4020

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	08/05/2021

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