1811210214 NPI number — MINER ADJUSTMENTS FAMILY CHIROPRACTIC P.C.

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 1811210214 NPI number — MINER ADJUSTMENTS FAMILY CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINER ADJUSTMENTS FAMILY CHIROPRACTIC P.C.
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:
1811210214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 OSSIAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14437-9101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-335-5868
Provider Business Mailing Address Fax Number:
585-335-5875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 OSSIAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14437-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-335-5868
Provider Business Practice Location Address Fax Number:
585-335-5875
Provider Enumeration Date:
03/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MINER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
CONAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-335-5868

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  70011814 , 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: 12060034 . This is a "CAQH NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 70011814 . This is a "NYS LICENSE NUMBER" identifier . This identifiers is of the category "OTHER".




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