Provider Demographics
NPI:1710073085
Name:MOONEY, RENEE M (DC)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:M
Last Name:MOONEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 MANLIUS CENTER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2999
Mailing Address - Country:US
Mailing Address - Phone:315-425-0009
Mailing Address - Fax:315-425-8881
Practice Address - Street 1:6701 MANLIUS CENTER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2999
Practice Address - Country:US
Practice Address - Phone:315-425-0009
Practice Address - Fax:315-425-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA7428OtherP-10
CC8005Medicare ID - Type Unspecified
U66568Medicare UPIN