Provider Demographics
NPI:1023217072
Name:OAK ORCHARD CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:OAK ORCHARD CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MERRITT
Authorized Official - Last Name:MISIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-589-9344
Mailing Address - Street 1:3912 OAK ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9552
Mailing Address - Country:US
Mailing Address - Phone:585-589-9344
Mailing Address - Fax:
Practice Address - Street 1:3912 OAK ORCHARD RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9552
Practice Address - Country:US
Practice Address - Phone:585-589-9344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007977-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14222AMedicare PIN