Provider Demographics
NPI:1972784379
Name:JEFFREY A. BYRNE, D.C., P.C.
Entity type:Organization
Organization Name:JEFFREY A. BYRNE, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-439-2643
Mailing Address - Street 1:4692 DRUIDS GLN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8432
Mailing Address - Country:US
Mailing Address - Phone:315-682-2718
Mailing Address - Fax:315-699-2302
Practice Address - Street 1:6253 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8714
Practice Address - Country:US
Practice Address - Phone:315-699-2219
Practice Address - Fax:315-699-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU56188Medicare UPIN
NY11530BMedicare PIN