Provider Demographics
NPI:1417156019
Name:CUNNINGHAM CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CUNNINGHAM CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-445-9941
Mailing Address - Street 1:210 OLD BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2810
Mailing Address - Country:US
Mailing Address - Phone:315-445-9941
Mailing Address - Fax:315-445-2073
Practice Address - Street 1:210 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2810
Practice Address - Country:US
Practice Address - Phone:315-445-9941
Practice Address - Fax:315-445-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004088-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1417156019Medicare PIN
NYBA0685Medicare PIN
NYT26634Medicare UPIN