Provider Demographics
NPI:1184638538
Name:HOSMER, KEITH LEWIN (DC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:LEWIN
Last Name:HOSMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 CAZENOVIA STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210
Mailing Address - Country:US
Mailing Address - Phone:716-824-5548
Mailing Address - Fax:716-824-5549
Practice Address - Street 1:154 CAZENOVIA STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210
Practice Address - Country:US
Practice Address - Phone:716-824-5548
Practice Address - Fax:716-824-5549
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0083201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12156BMedicare ID - Type Unspecified