Provider Demographics
NPI:1821015470
Name:ILES, KENNETH A (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:ILES
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 1:8129 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9518
Mailing Address - Country:US
Mailing Address - Phone:315-699-9887
Mailing Address - Fax:
Practice Address - Street 1:8129 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9518
Practice Address - Country:US
Practice Address - Phone:315-699-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0394Medicare ID - Type Unspecified
NYX44645Medicare UPIN