Healthcare Provider Details

I. General information

NPI: 1770552531
Provider Name (Legal Business Name): JEREMY L BARTHOLOMEW D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MAIN ST
WATERVILLE NY
13480-1108
US

IV. Provider business mailing address

PO BOX 315
WATERVILLE NY
13480-0315
US

V. Phone/Fax

Practice location:
  • Phone: 315-841-3010
  • Fax: 315-841-3020
Mailing address:
  • Phone: 315-841-3010
  • Fax: 315-841-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: