Provider Demographics
NPI:1093049611
Name:FINGER LAKES CHIROPRACTIC & MASSAGE THERAPY, PLLC
Entity Type:Organization
Organization Name:FINGER LAKES CHIROPRACTIC & MASSAGE THERAPY, PLLC
Other - Org Name:FINGER LAKES SPINE & BODY WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-844-3304
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-1153
Mailing Address - Country:US
Mailing Address - Phone:607-844-3304
Mailing Address - Fax:607-708-4191
Practice Address - Street 1:87 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:607-844-3304
Practice Address - Fax:607-708-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70 011737111N00000X
NY70 011401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty