Provider Demographics
NPI:1255306569
Name:LA BARBERA FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:LA BARBERA FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LA BARBERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-724-0368
Mailing Address - Street 1:2719 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6556
Mailing Address - Country:US
Mailing Address - Phone:315-724-0368
Mailing Address - Fax:315-724-0374
Practice Address - Street 1:2719 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6556
Practice Address - Country:US
Practice Address - Phone:315-724-0368
Practice Address - Fax:315-724-0374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0044131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0095251OtherGHI
0095251OtherGHI
AA0767Medicare ID - Type Unspecified