Provider Demographics
NPI:1649601022
Name:ALLIED SPINE AND SPORTS CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:ALLIED SPINE AND SPORTS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BARRETT
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:315-498-6888
Mailing Address - Street 1:100 INTREPID LN
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2546
Mailing Address - Country:US
Mailing Address - Phone:315-498-6888
Mailing Address - Fax:315-498-6889
Practice Address - Street 1:100 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2546
Practice Address - Country:US
Practice Address - Phone:315-498-6888
Practice Address - Fax:315-498-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1962593327Medicare PIN
NY1609108596Medicare PIN
NY1144299835Medicare PIN