Provider Demographics
NPI:1700266186
Name:FUSCO, KRISTIN D (DC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:FUSCO
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 1:4922 W SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2225
Mailing Address - Country:US
Mailing Address - Phone:315-857-5557
Mailing Address - Fax:
Practice Address - Street 1:4922 W SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2225
Practice Address - Country:US
Practice Address - Phone:315-857-5557
Practice Address - Fax:315-320-9235
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012792111N00000X
NY012949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor