Provider Demographics
NPI:1629119292
Name:BLANK, KENNETH NEIL (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:NEIL
Last Name:BLANK
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 1:92 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5408
Mailing Address - Country:US
Mailing Address - Phone:845-357-0699
Mailing Address - Fax:845-504-0732
Practice Address - Street 1:92 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5408
Practice Address - Country:US
Practice Address - Phone:845-357-0699
Practice Address - Fax:845-504-0732
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor