Provider Demographics
NPI:1588751457
Name:EMERSON, DENEAN MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:DENEAN
Middle Name:MARIE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-1121
Mailing Address - Country:US
Mailing Address - Phone:585-968-1883
Mailing Address - Fax:585-968-1883
Practice Address - Street 1:8 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1121
Practice Address - Country:US
Practice Address - Phone:585-968-1883
Practice Address - Fax:585-968-1883
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000224698001OtherBC-BS #
NY01 0489342 01OtherPRISM HEALTH CARE PAR. #
NY5899852OtherGHI PARTIPATING #
NYC07779-4OtherWORKERS' COMPENSATION
NYX007779OtherLICENSE
NYU65570Medicare UPIN
NY01 0489342 01OtherPRISM HEALTH CARE PAR. #