Provider Demographics
NPI:1811210214
Name:MINER ADJUSTMENTS FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:MINER ADJUSTMENTS FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CONAN
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-335-5868
Mailing Address - Street 1:88 OSSIAN ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9101
Mailing Address - Country:US
Mailing Address - Phone:585-335-5868
Mailing Address - Fax:585-335-5875
Practice Address - Street 1:88 OSSIAN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9101
Practice Address - Country:US
Practice Address - Phone:585-335-5868
Practice Address - Fax:585-335-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70011814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12060034OtherCAQH NUMBER
70011814OtherNYS LICENSE NUMBER