Provider Demographics
NPI:1508028416
Name:TOMPKINS COMMUNITY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:TOMPKINS COMMUNITY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:H
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-257-6217
Mailing Address - Street 1:435 FRANKLIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3570
Mailing Address - Country:US
Mailing Address - Phone:607-257-6217
Mailing Address - Fax:607-257-6847
Practice Address - Street 1:435 FRANKLIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3570
Practice Address - Country:US
Practice Address - Phone:607-257-6217
Practice Address - Fax:607-257-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005048261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1540Medicare PIN