Provider Demographics
NPI:1700157013
Name:HEALTHSOURCE OF HORNELL PROGRESSIVE CHIROPRACTIC REHABILITATION, P.C.
Entity Type:Organization
Organization Name:HEALTHSOURCE OF HORNELL PROGRESSIVE CHIROPRACTIC REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-324-2444
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-0358
Mailing Address - Country:US
Mailing Address - Phone:607-324-2444
Mailing Address - Fax:607-324-2524
Practice Address - Street 1:340 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1004
Practice Address - Country:US
Practice Address - Phone:607-324-2444
Practice Address - Fax:607-324-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0028931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty