Provider Demographics
NPI:1457465205
Name:KOCHMAN, KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:KOCHMAN
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 1:26 IBM RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5427
Mailing Address - Country:US
Mailing Address - Phone:845-462-8200
Mailing Address - Fax:
Practice Address - Street 1:26 IBM RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5427
Practice Address - Country:US
Practice Address - Phone:845-462-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX009735OtherSTATE LICENSE
NYC097354OtherNYS WORKER'S COMPENSATION
NYC097354OtherNYS WORKER'S COMPENSATION
NYV79978Medicare UPIN