Provider Demographics
NPI:1659518777
Name:TIER CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:TIER CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MISTRETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-687-2242
Mailing Address - Street 1:6 MCMASTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1029
Mailing Address - Country:US
Mailing Address - Phone:607-687-2242
Mailing Address - Fax:607-687-9128
Practice Address - Street 1:6 MCMASTER ST STE 1
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1029
Practice Address - Country:US
Practice Address - Phone:607-687-2242
Practice Address - Fax:607-687-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005973-1 NY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty