Provider Demographics
NPI:1104910967
Name:TERESA M BACH CARTHAGE FAMILY CHIROPRAC
Entity type:Organization
Organization Name:TERESA M BACH CARTHAGE FAMILY CHIROPRAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-493-0305
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-0070
Mailing Address - Country:US
Mailing Address - Phone:315-493-0305
Mailing Address - Fax:315-493-0305
Practice Address - Street 1:20284 COUNTY ROUTE 45
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9502
Practice Address - Country:US
Practice Address - Phone:315-493-0305
Practice Address - Fax:315-493-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0040721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO40727OtherWORKER'S COMP/NO FAULT
NY5803321OtherGROUP HEALTH INSURANCE
NY55363BMedicare ID - Type Unspecified