Provider Demographics
NPI:1043513989
Name:BODENSTEIN CHIROPRACTIC
Entity Type:Organization
Organization Name:BODENSTEIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-482-4442
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12748-0048
Mailing Address - Country:US
Mailing Address - Phone:845-482-4442
Mailing Address - Fax:845-482-4450
Practice Address - Street 1:4895 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12748
Practice Address - Country:US
Practice Address - Phone:845-482-4442
Practice Address - Fax:845-482-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX1C941Medicare PIN