Provider Demographics
NPI:1144397829
Name:LOTHLORIAN CHIROPRACTIC
Entity Type:Organization
Organization Name:LOTHLORIAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELAHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-835-3306
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:12117-0453
Mailing Address - Country:US
Mailing Address - Phone:518-661-7781
Mailing Address - Fax:
Practice Address - Street 1:2424 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:NY
Practice Address - Zip Code:12117-4000
Practice Address - Country:US
Practice Address - Phone:518-661-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55920AMedicare PIN