Provider Demographics
NPI:1003107954
Name:TESORIERO CHIROPRACTIC OFFICE, PC
Entity Type:Organization
Organization Name:TESORIERO CHIROPRACTIC OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TESORIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-343-5713
Mailing Address - Street 1:208 SYRACUSE AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3122
Mailing Address - Country:US
Mailing Address - Phone:315-343-5713
Mailing Address - Fax:315-343-5714
Practice Address - Street 1:208 SYRACUSE AVE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3122
Practice Address - Country:US
Practice Address - Phone:315-343-5713
Practice Address - Fax:315-343-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002605-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service