Provider Demographics
NPI:1316066335
Name:RADEMACKER, JEREMY WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WAYNE
Last Name:RADEMACKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 STERLING DR
Mailing Address - Street 2:STE 400
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1577
Mailing Address - Country:US
Mailing Address - Phone:716-675-5544
Mailing Address - Fax:716-675-5546
Practice Address - Street 1:200 STERLING DR
Practice Address - Street 2:STE 400
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1577
Practice Address - Country:US
Practice Address - Phone:716-675-5544
Practice Address - Fax:716-675-5546
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008352-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08352-9OtherWORKER'S COMPENSATION