Provider Demographics
NPI:1225892433
Name:PURE CHIROPRACTIC OF UTICA, PLLC
Entity Type:Organization
Organization Name:PURE CHIROPRACTIC OF UTICA, PLLC
Other - Org Name:PURE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-507-3635
Mailing Address - Street 1:419 MANDEVILLE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4611
Mailing Address - Country:US
Mailing Address - Phone:315-941-4872
Mailing Address - Fax:
Practice Address - Street 1:419 MANDEVILLE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4611
Practice Address - Country:US
Practice Address - Phone:315-941-4872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881297364OtherCHIROPRACTOR