Provider Demographics
NPI:1497178115
Name:CLARKE, KAITLYN (DC)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LOCUST HILL RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3129
Mailing Address - Country:US
Mailing Address - Phone:845-222-9842
Mailing Address - Fax:
Practice Address - Street 1:99 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1720
Practice Address - Country:US
Practice Address - Phone:914-202-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor