Healthcare Provider Details

I. General information

NPI: 1962448753
Provider Name (Legal Business Name): STUART WARREN ANKEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7864 TURIN RD
ROME NY
13440
US

IV. Provider business mailing address

7864 TURIN RD
ROME NY
13440
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-9240
  • Fax: 315-336-0744
Mailing address:
  • Phone: 315-337-9240
  • Fax: 315-336-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberC0000111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: