Provider Demographics
NPI:1396899423
Name:OWEGO CHIROPRACTIC PC
Entity type:Organization
Organization Name:OWEGO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LOVERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-687-3800
Mailing Address - Street 1:115 TEMPLE STREET
Mailing Address - Street 2:OWEGO CHIROPRACTIC PC
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1420
Mailing Address - Country:US
Mailing Address - Phone:607-687-3800
Mailing Address - Fax:607-687-6607
Practice Address - Street 1:115 TEMPLE STREET
Practice Address - Street 2:OWEGO CHIROPRACTIC PC
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1420
Practice Address - Country:US
Practice Address - Phone:607-687-3800
Practice Address - Fax:607-687-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54899AMedicare ID - Type Unspecified