Provider Demographics
NPI:1083772487
Name:SOUCY, MICHAEL REYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REYNE
Last Name:SOUCY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-4302
Mailing Address - Country:US
Mailing Address - Phone:315-963-8700
Mailing Address - Fax:315-963-8581
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-4302
Practice Address - Country:US
Practice Address - Phone:315-963-8700
Practice Address - Fax:315-963-8581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008475-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08475-8OtherWORKMANS COMPENSATION #
NYC08475-8OtherWORKMANS COMPENSATION #
NYV64541Medicare UPIN