Provider Demographics
NPI:1700867173
Name:DORNEMANN, KARYN MARIA (DC)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:MARIA
Last Name:DORNEMANN
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 1:2 SHERMAN POTTS DR
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075-3216
Mailing Address - Country:US
Mailing Address - Phone:518-828-2133
Mailing Address - Fax:518-822-1537
Practice Address - Street 1:2 SHERMAN POTTS DR
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3216
Practice Address - Country:US
Practice Address - Phone:518-828-2133
Practice Address - Fax:518-822-1537
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005279-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX34761Medicare UPIN
NYX34761Medicare ID - Type Unspecified