Provider Demographics
NPI:1508862228
Name:COMERFORD, KELLY A (DC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:COMERFORD
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 1:3403 CARMAN RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5319
Mailing Address - Country:US
Mailing Address - Phone:518-356-9835
Mailing Address - Fax:518-357-0470
Practice Address - Street 1:3403 CARMAN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-356-9835
Practice Address - Fax:518-357-0470
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0058732111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10026115OtherCDPHP
NYX43501OtherBCBS
NY10026115OtherCDPHP
NYX43501OtherBCBS