MEDICARE: MICHAEL JOSEPH LAMB DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	006780	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000013846	OTHER		EXCELLUS BCBS

General Provider Information

NPI Number	:	1396716197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH LAMB DC

Provider Business Mailing Address
First Line	:	5500 BARTEL RD
Second Line	:
City	:	BREWERTON
State	:	NY
Zip	:	13029-8792
Country	:	US
Telephone Number	:	315-676-4655
Fax Number	:	315-655-4044

Provider Business Practice Location Address
First Line	:	5500 BARTEL RD
Second Line	:
City	:	BREWERTON
State	:	NY
Zip	:	13029-8792
Country	:	US
Telephone Number	:	315-676-4655
Fax Number	:	315-655-4044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/07/2011

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