Provider Demographics
NPI:1265671440
Name:FAMILY ACUPUNCTURE & CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY ACUPUNCTURE & CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ERIC PARK
Authorized Official - Last Name:CORDES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD DC
Authorized Official - Phone:607-563-2273
Mailing Address - Street 1:GELDER MEDICAL GROUP BUILDING
Mailing Address - Street 2:44 PEARL STREET WEST
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1312
Mailing Address - Country:US
Mailing Address - Phone:607-563-2273
Mailing Address - Fax:
Practice Address - Street 1:GELDER MEDICAL GROUP BUILDING
Practice Address - Street 2:44 PEARL STREET WEST
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1312
Practice Address - Country:US
Practice Address - Phone:607-563-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011529111N00000X
NY3879171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty