Provider Demographics
NPI:1265427264
Name:VONDRA-HARWOOD, MICHELE L (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:L
Last Name:VONDRA-HARWOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:VONDRA-HARWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:609 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-3811
Mailing Address - Country:US
Mailing Address - Phone:315-393-1018
Mailing Address - Fax:315-393-1075
Practice Address - Street 1:609 CANTON ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3811
Practice Address - Country:US
Practice Address - Phone:315-393-1018
Practice Address - Fax:315-393-1075
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0083591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
56695BMedicare ID - Type Unspecified
NYU66390Medicare UPIN