Provider Demographics
NPI:1902832140
Name:KELLEHER, LAURIE A (DC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:KELLEHER
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 1:342 DOWNING DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4414
Mailing Address - Country:US
Mailing Address - Phone:914-302-2190
Mailing Address - Fax:914-302-2191
Practice Address - Street 1:342 DOWNING DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4414
Practice Address - Country:US
Practice Address - Phone:914-302-2190
Practice Address - Fax:914-302-2191
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5S921Medicare ID - Type Unspecified