Provider Demographics
NPI:1700934577
Name:KIRKLAND, ELIZABETH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:KIRKLAND
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:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-0813
Mailing Address - Country:US
Mailing Address - Phone:631-513-2501
Mailing Address - Fax:631-363-8122
Practice Address - Street 1:498 GILLETTE AVE
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1507
Practice Address - Country:US
Practice Address - Phone:631-513-2501
Practice Address - Fax:631-363-8122
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008302-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX92051Medicare ID - Type Unspecified