Provider Demographics
NPI:1245242098
Name:SKONBERG, KENNETH DREW (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DREW
Last Name:SKONBERG
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 1:3 PIERCES RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-561-6800
Mailing Address - Fax:845-561-7003
Practice Address - Street 1:3 PIERCES RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-6800
Practice Address - Fax:845-561-7003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005104111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81237Medicare UPIN
X34751Medicare ID - Type Unspecified