Provider Demographics
NPI:1134301419
Name:COOPERSTOWN FAMILY CHIORPRACTIC, PLLC
Entity Type:Organization
Organization Name:COOPERSTOWN FAMILY CHIORPRACTIC, PLLC
Other - Org Name:COOPERSTOWN FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-282-4140
Mailing Address - Street 1:4910 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-5212
Mailing Address - Country:US
Mailing Address - Phone:607-282-4140
Mailing Address - Fax:
Practice Address - Street 1:4910 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326
Practice Address - Country:US
Practice Address - Phone:607-282-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX 70 011479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty