Provider Demographics
NPI:1336454370
Name:ANN M. STUDER DC, PC
Entity Type:Organization
Organization Name:ANN M. STUDER DC, PC
Other - Org Name:CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-986-8868
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-0416
Mailing Address - Country:US
Mailing Address - Phone:845-986-8868
Mailing Address - Fax:845-986-9857
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1346
Practice Address - Country:US
Practice Address - Phone:845-986-8868
Practice Address - Fax:845-986-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008883-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU73676Medicare UPIN
NYX2B401Medicare PIN