Provider Demographics
NPI:1679669394
Name:SAUGERTIES CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SAUGERTIES CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-246-5020
Mailing Address - Street 1:2 MALDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477
Mailing Address - Country:US
Mailing Address - Phone:845-246-5020
Mailing Address - Fax:845-246-0414
Practice Address - Street 1:2 MALDEN AVENUE
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477
Practice Address - Country:US
Practice Address - Phone:845-246-5020
Practice Address - Fax:845-246-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52733Medicare UPIN
X23381Medicare ID - Type Unspecified