Provider Demographics
NPI:1740305531
Name:SOUTHSIDE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SOUTHSIDE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FININICIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-433-9661
Mailing Address - Street 1:531 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3211
Mailing Address - Country:US
Mailing Address - Phone:607-433-9661
Mailing Address - Fax:607-643-0306
Practice Address - Street 1:531 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3211
Practice Address - Country:US
Practice Address - Phone:607-433-9661
Practice Address - Fax:607-643-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty