Provider Demographics
NPI:1407933898
Name:BAUMAN, KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:BAUMAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:959 WASHINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1415
Mailing Address - Country:US
Mailing Address - Phone:518-489-4811
Mailing Address - Fax:518-489-6200
Practice Address - Street 1:959 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1415
Practice Address - Country:US
Practice Address - Phone:518-489-4811
Practice Address - Fax:518-489-6200
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0069931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6128OtherEMPIRE BCBS
NY10013383OtherCDPHP
NY10013383OtherCDPHP
54165BMedicare UPIN
NYX6128OtherEMPIRE BCBS