Provider Demographics
NPI:1013131929
Name:BIRCHENOUGH, KORI L (DC)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:L
Last Name:BIRCHENOUGH
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 1:425 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4868
Mailing Address - Country:US
Mailing Address - Phone:315-529-0678
Mailing Address - Fax:
Practice Address - Street 1:53 S 3RD ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1844
Practice Address - Country:US
Practice Address - Phone:315-593-7555
Practice Address - Fax:315-207-0023
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010641-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor