1003107954 NPI number — TESORIERO CHIROPRACTIC OFFICE, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003107954 NPI number — TESORIERO CHIROPRACTIC OFFICE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TESORIERO CHIROPRACTIC OFFICE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003107954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 SYRACUSE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSWEGO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13126-3122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-343-5713
Provider Business Mailing Address Fax Number:
315-343-5714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 SYRACUSE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13126-3122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-343-5713
Provider Business Practice Location Address Fax Number:
315-343-5714
Provider Enumeration Date:
04/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TESORIERO
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
315-343-5713

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  X002605-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com