Provider Demographics
NPI:1417060906
Name:NOONAN, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:NOONAN
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 1:1745 ROUTE 9 STE G
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2470
Mailing Address - Country:US
Mailing Address - Phone:518-581-9525
Mailing Address - Fax:518-581-9525
Practice Address - Street 1:1745 ROUTE 9 STE G
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2470
Practice Address - Country:US
Practice Address - Phone:518-581-9525
Practice Address - Fax:518-581-9525
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV07492Medicare UPIN
NYIA0858Medicare ID - Type Unspecified