Provider Demographics
NPI:1598117905
Name:MARKET STREET CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MARKET STREET CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-936-4141
Mailing Address - Street 1:29 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2658
Mailing Address - Country:US
Mailing Address - Phone:607-936-4141
Mailing Address - Fax:
Practice Address - Street 1:29 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2658
Practice Address - Country:US
Practice Address - Phone:607-936-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011022111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty