Provider Demographics
NPI:1114064516
Name:PATENAUDE CHIROPRACTIC LLP
Entity type:Organization
Organization Name:PATENAUDE CHIROPRACTIC LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PATENAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-664-4525
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170-0427
Mailing Address - Country:US
Mailing Address - Phone:518-664-4525
Mailing Address - Fax:518-664-1256
Practice Address - Street 1:781 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:NY
Practice Address - Zip Code:12170-0427
Practice Address - Country:US
Practice Address - Phone:518-664-4525
Practice Address - Fax:518-664-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0831Medicare ID - Type Unspecified