Healthcare Provider Details

I. General information

NPI: 1447787460
Provider Name (Legal Business Name): DIG DEEP CHIROPRACTIC & MASSAGE THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 01/25/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 JOHNSON RD
LATHAM NY
12110-3051
US

IV. Provider business mailing address

595 NEW LOUDON RD # 148
LATHAM NY
12110-4063
US

V. Phone/Fax

Practice location:
  • Phone: 518-289-0408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS PATTERSON
Title or Position: PARTNET
Credential: DC
Phone: 518-406-8788