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NPI Code Detail

MEDICARE: DR. KELLY ANN DWYER D.C.

MEDICARE:  DR. KELLY ANN DWYER  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
1111N00000XChiropractorX011007-1NY

General Provider Information

NPI Number : 1962477448
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY ANN DWYER D.C.
Provider Business Mailing Address
First Line : 74 BUFFALO AVE
Second Line :
City : EAST ATLANTIC BEACH
State : NY
Zip : 11561-1028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 E 42ND ST
Second Line : SUITE 200
City : NEW YORK
State : NY
Zip : 10017-5405
Country : US
Telephone Number : 212-867-0405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 07/09/2007

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Directions to “ DR. KELLY ANN DWYER D.C.” Practice Location

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