Provider Demographics
NPI:1831126838
Name:HANSLICK, ALFRED JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:JOSEPH
Last Name:HANSLICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1365
Mailing Address - Country:US
Mailing Address - Phone:315-331-1801
Mailing Address - Fax:315-331-1802
Practice Address - Street 1:513 W UNION ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1365
Practice Address - Country:US
Practice Address - Phone:315-331-1801
Practice Address - Fax:315-331-1802
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003266-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02264657Medicaid
NY103264ANOtherPREFERRED CARE
NY5201328OtherAETNA
NYRC70003266OtherPOMCO
NY17896CMedicare ID - Type Unspecified