Provider Demographics
NPI:1336227768
Name:NOONAN, DAVID A (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:NOONAN
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 1:123 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4181
Mailing Address - Country:US
Mailing Address - Phone:518-384-0877
Mailing Address - Fax:518-384-0879
Practice Address - Street 1:123 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4181
Practice Address - Country:US
Practice Address - Phone:518-384-0877
Practice Address - Fax:518-384-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33471OtherEMPIRE BLUE CROSS BLUE SH
RA9547Medicare PIN