Basic Information
| Provider Information | |||||||||
| NPI: | 1154400240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANKE | ||||||||
| FirstName: | KIRBY | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W FAYETTE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132042859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154721488 | ||||||||
| FaxNumber: | 3154761792 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 FENNELL ST | ||||||||
| Address2: | |||||||||
| City: | SKANEATELES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131521137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156851655 | ||||||||
| FaxNumber: | 3156851657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | PT007472 | NY | N | Chiropractic Providers | Chiropractor | 225100000X | PT007472 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.