Kelli Leigh Patenaude, D.C.
Individual provider Active NPI Chiropractor · Stillwater, NY
NPI 1366465593 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366465593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 011154 (NY)
- Practice address
- 172 Hudson Ave.
Stillwater, NY 12170-0427 - Phone
- (518) 664-4525
- Fax
- (518) 664-1256
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- New York Chiropractic College, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Patenaude Chiropractic LLP
Practice addresses (Care Compare)
781 Hudson Ave
Stillwater, NY 12170-7717
Phone (518) 664-4525
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060323000108 | NY | Practitioner - Chiropractic | 7618984667 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011154 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patenaude Chiropractic LLP | Chiropractor | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 011154 | NY | Yes |
Addresses
Primary practice location
172 Hudson Ave.
Stillwater, NY 12170-0427
Mailing address
P.O. Box 427
Stillwater, NY 12170-0427
Phone (518) 664-4525
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10110754 | Other | NY | CDPHP |
| 1065576 | Other | NY | ASHN |
| X08P31 | Other | NY | BLUE CROSS / BLUE SHIELD |
| 20406141101 | Other | NY | PRISM HEALTH NETWORK |
| NY11154 | Other | NY | MVP HEALTH PLAN |
| C11154-4W | Other | NY | WORKERS' COMPENSATION |
| 204061411 | Other | NY | LANDMARK |
Other providers in Stillwater, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.