Provider Demographics
NPI:1770669640
Name:BUNBURY, KERI (DC)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:
Last Name:BUNBURY
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 1:40 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-331-8010
Mailing Address - Fax:845-331-8961
Practice Address - Street 1:40 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-331-8010
Practice Address - Fax:845-331-8961
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0109671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX05K01Medicare PIN