Provider Demographics
NPI:1740583483
Name:HOMER CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:HOMER CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERCZEG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-749-3857
Mailing Address - Street 1:21 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1022
Mailing Address - Country:US
Mailing Address - Phone:607-749-3857
Mailing Address - Fax:607-749-3862
Practice Address - Street 1:21 S WEST ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1022
Practice Address - Country:US
Practice Address - Phone:607-749-3857
Practice Address - Fax:607-749-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70092135261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center