MEDICARE: ADIRONDACK CHIROPRACTIC PC

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	X005212	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51846B	OTHER	NY	MEDICARE P10

General Provider Information

NPI Number	:	1407093438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADIRONDACK CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	230 5TH AVE EXT
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1820
Country	:	US
Telephone Number	:	518-773-2000
Fax Number	:	518-773-2663

Provider Business Practice Location Address
First Line	:	230 5TH AVE EXT
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1820
Country	:	US
Telephone Number	:	518-773-2000
Fax Number	:	518-773-2663

Authorized Official
Title or Position	:	OWNER
Name	:	JIM P TAMULAITIS
Credential	:	D.C.
Telephone Number	:	518-773-2000

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	09/18/2014

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