Provider Demographics
NPI:1952421034
Name:AUGUSTINE, KEVIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 CAYUGA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1723
Mailing Address - Country:US
Mailing Address - Phone:716-754-2225
Mailing Address - Fax:
Practice Address - Street 1:769 CAYUGA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1723
Practice Address - Country:US
Practice Address - Phone:716-754-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009003-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor