MEDICARE: DR. ALLAN WATTENMAKER D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X009236	NY
2	111N00000X	Chiropractor	38MC0058300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	616362	OTHER	NY	ACN
2	C092363B	OTHER	NY	WORKER'S COMP
3	002246327-001	OTHER	NY	UNITED HEALTHVARE
4	01-0742307	OTHER	NY	HORIZON
5	050009236NY01	OTHER	NY	ANTHEM BC/BS
6	4982374	OTHER	NY	CIGNA
7	360241	OTHER	NY	MVP
8	P2696703	OTHER	NY	OXFORD
9	01-0742307	OTHER	NY	EMPIRE BC/BS
10	9250286	OTHER	NY	PHCS
11	01-0742307	OTHER	NY	POMCO
12	4C5009	OTHER	NY	HEALTHNET
13	2949788	OTHER	NY	AETNA
14	5898060	OTHER	NY	GHI
15	832468	OTHER	NY	MPN

General Provider Information

NPI Number	:	1124059357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN WATTENMAKER D.C.

Provider Business Mailing Address
First Line	:	56 QUARRY LN
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1539
Country	:	US
Telephone Number	:	914-646-6893
Fax Number	:	914-234-2661

Provider Business Practice Location Address
First Line	:	56 QUARRY LN
Second Line	:
City	:	BEDFORD
State	:	NY
Zip	:	10506-1539
Country	:	US
Telephone Number	:	914-646-6893
Fax Number	:	914-234-2661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2010

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