Provider Demographics
NPI:1336409390
Name:INNATE EMPOWERMENT A CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:INNATE EMPOWERMENT A CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:KB CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-331-8010
Mailing Address - Street 1:40 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6202
Mailing Address - Country:US
Mailing Address - Phone:845-331-8010
Mailing Address - Fax:845-331-8961
Practice Address - Street 1:40 BOULEVARD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6202
Practice Address - Country:US
Practice Address - Phone:845-331-8010
Practice Address - Fax:845-331-8961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX05K01111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX05K01Medicare PIN