Individual
KIM STUART VAN DER VEER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC, CCSP
Contact information
Practice address
1134 TROY SCHENECTADY RD, LATHAM, NY 12110-1006
(518) 783-1908
(518) 783-1909
Mailing address
1134 TROY SCHENECTADY RD, LATHAM, NY 12110-1006
(518) 783-1908
(518) 783-1909
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
X005017
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000445021001
BLUE SHIELD PROV. #
NY
01
—
0013200
GHI
NY
01
—
10019433
CDPHP PROV. #
NY
01
—
141690724-01
PRISM PROV. #
NY
01
—
566114
UNITED HEALTHCARE
NY
01
—
911601
ACN GROUP
NY
01
—
X3317
BCBS PROV. #
NY
Enumeration date
03/27/2006
Last updated
07/08/2007
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