Provider Demographics
NPI:1942343199
Name:WRIEDEN FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:WRIEDEN FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WRIEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-336-7030
Mailing Address - Street 1:60 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1542
Mailing Address - Country:US
Mailing Address - Phone:607-336-7030
Mailing Address - Fax:
Practice Address - Street 1:60 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1542
Practice Address - Country:US
Practice Address - Phone:607-336-7030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1328Medicare ID - Type UnspecifiedGROUP NUMBER