Provider Demographics
NPI:1134264120
Name:MEDWIN, KERSTIN N (DC)
Entity type:Individual
Prefix:
First Name:KERSTIN
Middle Name:N
Last Name:MEDWIN
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 1:407 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1902
Mailing Address - Country:US
Mailing Address - Phone:518-435-1280
Mailing Address - Fax:518-435-1284
Practice Address - Street 1:407 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1902
Practice Address - Country:US
Practice Address - Phone:518-435-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010877-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10088278OtherCDPHP
NYC10877-1BOtherWORKER'S COMPENSATION
NYC10877-1BOtherWORKER'S COMPENSATION
NYIA0754Medicare ID - Type Unspecified