Provider Demographics
NPI:1386862472
Name:GLENMONT CHIROPRACTIC OFFICE, PLLC
Entity Type:Organization
Organization Name:GLENMONT CHIROPRACTIC OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-449-3071
Mailing Address - Street 1:398 FEURA BUSH RD
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-2954
Mailing Address - Country:US
Mailing Address - Phone:518-449-3071
Mailing Address - Fax:518-449-3073
Practice Address - Street 1:398 FEURA BUSH RD
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-2954
Practice Address - Country:US
Practice Address - Phone:518-449-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1681OtherMEDICARE ORGANIZATION
NYT32187Medicare UPIN
NYAA1681OtherMEDICARE ORGANIZATION