Provider Demographics
NPI:1811126667
Name:PIERATTI, KENNETH J (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:PIERATTI
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 1:112 RED MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2752
Mailing Address - Country:US
Mailing Address - Phone:845-628-6778
Mailing Address - Fax:
Practice Address - Street 1:2676 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4914
Practice Address - Country:US
Practice Address - Phone:718-733-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007760-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor