Provider Demographics
NPI:1598999161
Name:WITKOP HOMETOWN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WITKOP HOMETOWN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:WITKOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-705-4410
Mailing Address - Street 1:213 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1904
Mailing Address - Country:US
Mailing Address - Phone:315-705-4410
Mailing Address - Fax:315-705-4610
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1904
Practice Address - Country:US
Practice Address - Phone:315-705-4410
Practice Address - Fax:315-705-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty