Provider Demographics
NPI:1356491740
Name:ACKERMAN, DREW K (DC)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:K
Last Name:ACKERMAN
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 1:114 RYERSON RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2926
Mailing Address - Country:US
Mailing Address - Phone:845-986-3322
Mailing Address - Fax:
Practice Address - Street 1:114 RYERSON RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2926
Practice Address - Country:US
Practice Address - Phone:845-986-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18295111N00000X
NYX010094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOOL41Medicare ID - Type Unspecified