Provider Demographics
NPI:1851430904
Name:JONATHAN MULHOLLAND, DC
Entity Type:Organization
Organization Name:JONATHAN MULHOLLAND, DC
Other - Org Name:PLATTSBURGH SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULHOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-324-2700
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0268
Mailing Address - Country:US
Mailing Address - Phone:518-324-2700
Mailing Address - Fax:518-324-2710
Practice Address - Street 1:33 DURKEE ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2999
Practice Address - Country:US
Practice Address - Phone:518-324-2700
Practice Address - Fax:518-324-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009992111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty