Provider Demographics
NPI:1093838716
Name:ONEIDA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ONEIDA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRZYBYLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-363-0038
Mailing Address - Street 1:204 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2102
Mailing Address - Country:US
Mailing Address - Phone:315-363-0038
Mailing Address - Fax:315-363-0038
Practice Address - Street 1:204 BROAD ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2102
Practice Address - Country:US
Practice Address - Phone:315-363-0038
Practice Address - Fax:315-363-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54442AMedicare ID - Type UnspecifiedCHIROPRACTIC