Provider Demographics
NPI:1336208883
Name:KESHMIRI, REBECCA (DC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KESHMIRI
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 1:1116 ARSENAL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2229
Mailing Address - Country:US
Mailing Address - Phone:315-782-7166
Mailing Address - Fax:315-782-0978
Practice Address - Street 1:1116 ARSENAL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2229
Practice Address - Country:US
Practice Address - Phone:315-782-7166
Practice Address - Fax:315-782-0978
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX 007976-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY07976OtherLANDMARK
NYP01000796OtherBLUECROSS BLUESHIELD
NY5805783OtherGHI
NY9L1470OtherMVP
NYNY07976OtherLANDMARK
NYCC9936Medicare ID - Type UnspecifiedMEDICARE