Provider Demographics
NPI:1407613391
Name:IDEAL ATHLETE CHIROPRACTIC
Entity Type:Organization
Organization Name:IDEAL ATHLETE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-324-5000
Mailing Address - Street 1:43 DURKEE ST STE 600C
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2953
Mailing Address - Country:US
Mailing Address - Phone:518-324-5000
Mailing Address - Fax:518-324-5500
Practice Address - Street 1:43 DURKEE ST STE 600C
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2953
Practice Address - Country:US
Practice Address - Phone:518-324-5000
Practice Address - Fax:518-324-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty