Provider Demographics
NPI:1912462714
Name:BINGHAMTON CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BINGHAMTON CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-354-0985
Mailing Address - Street 1:212 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3202
Mailing Address - Country:US
Mailing Address - Phone:607-437-1795
Mailing Address - Fax:
Practice Address - Street 1:95 COURT ST STE G1
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3312
Practice Address - Country:US
Practice Address - Phone:607-354-0985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty