Provider Demographics
NPI:1154435519
Name:EAGLE, KEN (DC BCN)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:EAGLE
Suffix:
Gender:M
Credentials:DC BCN
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 58
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-0058
Mailing Address - Country:US
Mailing Address - Phone:516-381-9055
Mailing Address - Fax:
Practice Address - Street 1:3 SWAN CT
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1307
Practice Address - Country:US
Practice Address - Phone:516-381-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008036-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor