Provider Demographics
NPI:1316086804
Name:COMMUNITY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:COMMUNITY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-592-4740
Mailing Address - Street 1:16 CANALVIEW MALL
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1733
Mailing Address - Country:US
Mailing Address - Phone:315-592-4740
Mailing Address - Fax:315-592-7423
Practice Address - Street 1:16 CANALVIEW MALL
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1733
Practice Address - Country:US
Practice Address - Phone:315-592-4740
Practice Address - Fax:315-592-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0402Medicare PIN