Provider Demographics
NPI:1972502342
Name:CHAMPLIN, MARYANN (DC)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:CHAMPLIN
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 1:26 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-4334
Mailing Address - Country:US
Mailing Address - Phone:607-843-2811
Mailing Address - Fax:607-843-2811
Practice Address - Street 1:26 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-4334
Practice Address - Country:US
Practice Address - Phone:607-843-2811
Practice Address - Fax:607-843-2811
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB9855Medicare ID - Type Unspecified
T12604Medicare UPIN