Provider Demographics
NPI:1003901083
Name:ROMAINE, KIMBERLY ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:ROMAINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3467
Mailing Address - Country:US
Mailing Address - Phone:631-281-0966
Mailing Address - Fax:631-281-0966
Practice Address - Street 1:283 WILLIAM FLOYD PKWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3467
Practice Address - Country:US
Practice Address - Phone:631-281-0966
Practice Address - Fax:631-281-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004616-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO4616-0OtherWORKER'S COMPENSATION #
NYX42801Medicare ID - Type UnspecifiedMEDICARE NUMBER