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General NPI Number Information
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NPI Number | 1164046934
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MCINTYRE D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 7 BUSH PARK LN
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City | PENN YAN
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State | NY
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Zip | 14527-1727
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Country | US
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Telephone | 315-551-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 401 CLINTON ST APT 1
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City | PENN YAN
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State | NY
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Zip | 14527-1385
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Country | US
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Telephone | 315-551-0211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | X013370
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License Number State | NY
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