Provider Demographics
NPI:1104048792
Name:UPSTATE FAMILY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:UPSTATE FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAILING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-866-3646
Mailing Address - Street 1:300 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1911
Mailing Address - Country:US
Mailing Address - Phone:315-866-3646
Mailing Address - Fax:315-866-6400
Practice Address - Street 1:300 N PROSPECT ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1911
Practice Address - Country:US
Practice Address - Phone:315-866-3646
Practice Address - Fax:315-866-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007-584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5295Medicare ID - Type Unspecified
NYU4760Medicare UPIN