Healthcare Provider Details

I. General information

NPI: 1598117905
Provider Name (Legal Business Name): MARKET STREET CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2016
Last Update Date: 07/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 E MARKET ST
CORNING NY
14830-2658
US

IV. Provider business mailing address

29 E MARKET ST
CORNING NY
14830-2658
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-4141
  • Fax:
Mailing address:
  • Phone: 607-936-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX011022
License Number StateNY

VIII. Authorized Official

Name: SCOTT BERES
Title or Position: PRESIDENT
Credential: DC
Phone: 607-936-4141