Provider Demographics
NPI:1437154655
Name:GERMOND, MATTHEW BERNARD (DC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BERNARD
Last Name:GERMOND
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 1:109 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733
Mailing Address - Country:US
Mailing Address - Phone:607-967-2000
Mailing Address - Fax:607-967-2004
Practice Address - Street 1:109 NORTH MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BAINBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13733
Practice Address - Country:US
Practice Address - Phone:607-967-2000
Practice Address - Fax:607-967-2004
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009101-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09101OtherMVP
5898461OtherGHI
7194094OtherAETNA
C09101-9OtherWORKERS COMP
10064161OtherCDPHP
3878490001OtherNSC INDEN #
98L1051OtherLANDMARK AC
X4C66OtherEMPIRE BC/BS
NY09101OtherMVP
5898461OtherGHI