Provider Demographics
NPI:1437119062
Name:VAN DER VEER, KIM STUART (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:STUART
Last Name:VAN DER VEER
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 TROY SCHENECTADY RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1006
Mailing Address - Country:US
Mailing Address - Phone:518-783-1908
Mailing Address - Fax:518-783-1909
Practice Address - Street 1:1134 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1006
Practice Address - Country:US
Practice Address - Phone:518-783-1908
Practice Address - Fax:518-783-1909
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005017111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141690724-01OtherPRISM PROV. #
NY10019433OtherCDPHP PROV. #
NY000445021001OtherBLUE SHIELD PROV. #
NY566114OtherUNITED HEALTHCARE
NY0013200OtherGHI
NY911601OtherACN GROUP
NYX3317OtherBCBS PROV. #
NY911601OtherACN GROUP