Provider Demographics
NPI:1356749097
Name:AMY, JUSTIN KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KYLE
Last Name:AMY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 JOHNSON RD
Mailing Address - Street 2:STE 1
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3051
Mailing Address - Country:US
Mailing Address - Phone:570-709-3566
Mailing Address - Fax:518-456-0942
Practice Address - Street 1:8 CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5186
Practice Address - Country:US
Practice Address - Phone:518-608-4446
Practice Address - Fax:518-456-0942
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty