Healthcare Provider Details

I. General information

NPI: 1225892433
Provider Name (Legal Business Name): PURE CHIROPRACTIC OF UTICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 GENESEE ST
UTICA NY
13501-6222
US

IV. Provider business mailing address

2709 GENESEE ST
UTICA NY
13501-6222
US

V. Phone/Fax

Practice location:
  • Phone: 315-797-1908
  • Fax:
Mailing address:
  • Phone: 315-797-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ENISA LATIC
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 315-797-1908