Provider Demographics
NPI:1295014835
Name:VESTAL FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:VESTAL FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PREMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMANATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-239-4310
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1545
Mailing Address - Country:US
Mailing Address - Phone:607-239-4310
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1545
Practice Address - Country:US
Practice Address - Phone:607-239-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-14
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011999-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty