Provider Demographics
NPI:1124059357
Name:WATTENMAKER, ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:WATTENMAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 QUARRY LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-1539
Mailing Address - Country:US
Mailing Address - Phone:914-646-6893
Mailing Address - Fax:914-234-2661
Practice Address - Street 1:56 QUARRY LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NY
Practice Address - Zip Code:10506-1539
Practice Address - Country:US
Practice Address - Phone:914-646-6893
Practice Address - Fax:914-234-2661
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009236111N00000X
NJ38MC0058300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY616362OtherACN
NYC092363BOtherWORKER'S COMP
NY002246327-001OtherUNITED HEALTHVARE
NY01-0742307OtherHORIZON
NY050009236NY01OtherANTHEM BC/BS
NY4982374OtherCIGNA
NY360241OtherMVP
NYP2696703OtherOXFORD
NY01-0742307OtherEMPIRE BC/BS
NY9250286OtherPHCS
NY01-0742307OtherPOMCO
NY4C5009OtherHEALTHNET
NY2949788OtherAETNA
NY5898060OtherGHI
NY832468OtherMPN
NY4982374OtherCIGNA
NY832468OtherMPN