Provider Demographics
NPI:1346206703
Name:DELMEDICO, TIMOTHY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:DELMEDICO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6222
Mailing Address - Country:US
Mailing Address - Phone:315-797-1908
Mailing Address - Fax:315-797-1193
Practice Address - Street 1:2709 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6222
Practice Address - Country:US
Practice Address - Phone:315-797-1908
Practice Address - Fax:315-797-1193
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6286260001Medicare NSC
CC9819Medicare PIN