Provider Demographics
NPI:1619233400
Name:DR. KIM LEIS-KEELING, DC, PLLC
Entity Type:Organization
Organization Name:DR. KIM LEIS-KEELING, DC, PLLC
Other - Org Name:SPINAL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEIS-KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-869-3415
Mailing Address - Street 1:1474 SIVER RD
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9775
Mailing Address - Country:US
Mailing Address - Phone:518-982-0200
Mailing Address - Fax:
Practice Address - Street 1:2021 WESTERN AVE
Practice Address - Street 2:102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5069
Practice Address - Country:US
Practice Address - Phone:518-869-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009338-1111N00000X
NYX012138-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty