Provider Demographics
NPI:1528082740
Name:KOHL, SETH G (DC)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:G
Last Name:KOHL
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 1:372 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3008
Mailing Address - Country:US
Mailing Address - Phone:518-489-6460
Mailing Address - Fax:518-459-4815
Practice Address - Street 1:372 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3008
Practice Address - Country:US
Practice Address - Phone:518-489-6460
Practice Address - Fax:518-459-4815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005269-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51504BMedicare ID - Type Unspecified