1033366703 NPI number — LEROY CHIROPRACTIC PLLC

Table of content: (NPI 1033366703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033366703 NPI number — LEROY CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEROY CHIROPRACTIC PLLC
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:
1033366703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7133 W MAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LE ROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14482-9352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-768-2890
Provider Business Mailing Address Fax Number:
585-769-2957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7133 W MAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LE ROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14482-9352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-768-2890
Provider Business Practice Location Address Fax Number:
585-769-2957
Provider Enumeration Date:
08/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SANEWSKY
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
OWNER/OPERATING MANAGER
Authorized Official Telephone Number:
585-768-2890

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X009184 , 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)

  • Identifier: PO40019184 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7677315 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PO10019184 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 106036AN . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8813182 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO9184-5B . This is a "WORKER'S COMP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com