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General NPI Number Information
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NPI Number | 1134301419
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Entity Type | Organization
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Legal Business Name | COOPERSTOWN FAMILY CHIORPRACTIC, PLLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 4910 STATE HIGHWAY 28
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City | COOPERSTOWN
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State | NY
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Zip | 13326
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Country | US
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Telephone | 607-282-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 4910 STATE HIGHWAY 28
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City | COOPERSTOWN
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State | NY
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Zip | 13326-5212
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Country | US
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Telephone | 607-282-4140
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. MATTHEW D CRAIG
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Credential | DC
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Telephone | 607-282-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X 70 011479
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License Number State | NY
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