Provider Demographics
NPI:1053583765
Name:LAURIE A. KELLEHER, DC, PC
Entity type:Organization
Organization Name:LAURIE A. KELLEHER, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-302-2190
Mailing Address - Street 1:342 DOWNING DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4414
Mailing Address - Country:US
Mailing Address - Phone:914-302-2190
Mailing Address - Fax:914-302-2191
Practice Address - Street 1:342 DOWNING DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4414
Practice Address - Country:US
Practice Address - Phone:914-302-2190
Practice Address - Fax:914-302-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100000118Medicare PIN