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General NPI Number Information
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NPI Number | 1659518777
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Entity Type | Organization
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Legal Business Name | TIER CHIROPRACTIC OFFICES
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 6 MCMASTER ST STE 1
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City | OWEGO
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State | NY
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Zip | 13827-1029
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Country | US
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Telephone | 607-687-2242
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Fax | 607-687-9128
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Provider Business Mailing Address
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Address Line | 6 MCMASTER ST STE 1
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City | OWEGO
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State | NY
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Zip | 13827-1029
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Country | US
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Telephone | 607-687-2242
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Fax | 607-687-9128
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MARK MISTRETTA
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Credential | D.C.
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Telephone | 607-687-2242
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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 | X005973-1 NY
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License Number State | NY
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