Provider Demographics
NPI:1720700792
Name:MCCARTY, PETER GLEN (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:GLEN
Last Name:MCCARTY
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 1:1900 RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3336
Mailing Address - Country:US
Mailing Address - Phone:716-677-2969
Mailing Address - Fax:716-674-2969
Practice Address - Street 1:1900 RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3336
Practice Address - Country:US
Practice Address - Phone:716-677-2969
Practice Address - Fax:716-674-2969
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor