Provider Demographics
NPI:1386721645
Name:KISH, KURT C (DC)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:C
Last Name:KISH
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 1:748 FREEDOM PLAINS RD.
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603
Mailing Address - Country:US
Mailing Address - Phone:845-485-4488
Mailing Address - Fax:845-485-4420
Practice Address - Street 1:748 FREEDOM PLAINS RD.
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603
Practice Address - Country:US
Practice Address - Phone:845-485-4488
Practice Address - Fax:845-485-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP890780OtherOXFORD INSURANCE CO.
NYP890780OtherOXFORD INSURANCE CO.
NYT52726Medicare UPIN