Provider Demographics
NPI:1093898736
Name:SCHALLER, JONATHAN D (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:D
Last Name:SCHALLER
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 1:23 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1303
Mailing Address - Country:US
Mailing Address - Phone:315-824-2504
Mailing Address - Fax:315-824-2504
Practice Address - Street 1:23 BROAD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1303
Practice Address - Country:US
Practice Address - Phone:315-824-2504
Practice Address - Fax:315-824-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX008682OtherNYS REGESTRATION
NYX008682OtherNYS REGESTRATION