Provider Demographics
NPI:1699897876
Name:KONIG, MICHAEL (PHD, DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KONIG
Suffix:
Gender:M
Credentials:PHD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 MADISON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6717
Mailing Address - Country:US
Mailing Address - Phone:212-684-2121
Mailing Address - Fax:
Practice Address - Street 1:143 MADISON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6717
Practice Address - Country:US
Practice Address - Phone:212-684-2121
Practice Address - Fax:212-684-2291
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX58081Medicare ID - Type UnspecifiedID NUMBER USED FOR CLAIMS