Provider Demographics
NPI:1598160590
Name:KABARI, KINGSLEY D (STUDENT)
Entity Type:Individual
Prefix:DR
First Name:KINGSLEY
Middle Name:D
Last Name:KABARI
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2324
Mailing Address - Country:US
Mailing Address - Phone:404-823-4154
Mailing Address - Fax:
Practice Address - Street 1:1963 US ROUTE 20
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-8552
Practice Address - Country:US
Practice Address - Phone:315-539-3066
Practice Address - Fax:315-651-4194
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012607-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor