Provider Demographics
NPI:1417128281
Name:CMC CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CMC CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FUYUKO
Authorized Official - Middle Name:IKEHARA
Authorized Official - Last Name:ODDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-622-1500
Mailing Address - Street 1:8134 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1500
Mailing Address - Country:US
Mailing Address - Phone:315-622-1500
Mailing Address - Fax:
Practice Address - Street 1:8134 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1500
Practice Address - Country:US
Practice Address - Phone:315-622-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYY35987Medicare UPIN
NYBA0575Medicare PIN