Provider Demographics
NPI:1124145453
Name:KAISER, SETH ALAN (DC, PT)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:ALAN
Last Name:KAISER
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ELM ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2535
Mailing Address - Country:US
Mailing Address - Phone:716-652-1803
Mailing Address - Fax:176-652-1951
Practice Address - Street 1:121 ELM ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2535
Practice Address - Country:US
Practice Address - Phone:716-652-1803
Practice Address - Fax:176-652-1951
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5775111N00000X
NY6160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8331Medicare ID - Type UnspecifiedDC INDIVIDUAL #
NYCC9224Medicare ID - Type UnspecifiedPT INDIVIDUAL #
NYT91762Medicare UPIN