Provider Demographics
NPI:1831146653
Name:SOUTHERN TIER CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SOUTHERN TIER CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-444-5585
Mailing Address - Street 1:269 RIVERSIDE DR # 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2726
Mailing Address - Country:US
Mailing Address - Phone:074-445-5856
Mailing Address - Fax:072-382-8656
Practice Address - Street 1:269 RIVERSIDE DR # 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:074-445-5585
Practice Address - Fax:607-238-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0058Medicare ID - Type UnspecifiedUPSTATE MEDICARE