Healthcare Provider Details

I. General information

NPI: 1265671440
Provider Name (Legal Business Name): FAMILY ACUPUNCTURE & CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GELDER MEDICAL GROUP BUILDING 44 PEARL STREET WEST
SIDNEY NY
13838-1312
US

IV. Provider business mailing address

GELDER MEDICAL GROUP BUILDING 44 PEARL STREET WEST
SIDNEY NY
13838-1312
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-2273
  • Fax:
Mailing address:
  • Phone: 607-563-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011529
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3879
License Number StateNY

VIII. Authorized Official

Name: RICK ERIC PARK CORDES
Title or Position: MEMBER
Credential: PHD DC
Phone: 607-563-2273