Healthcare Provider Details

I. General information

NPI: 1538471289
Provider Name (Legal Business Name): NORTH ENDICOTT CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PINE ST
ENDICOTT NY
13760-2715
US

IV. Provider business mailing address

817 PINE ST
ENDICOTT NY
13760-2715
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-7669
  • Fax:
Mailing address:
  • Phone: 607-754-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL ADAM COOPER
Title or Position: CEO
Credential: D.C.
Phone: 607-754-7669