Provider Demographics
NPI:1508963869
Name:CUNNINGHAM, GEORGE T (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:CUNNINGHAM
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 1:210 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4088-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8462Medicare PIN
NY1508963869Medicare PIN