Provider Demographics
NPI:1205051158
Name:SACKETS HARBOR CHIROPRACTIC
Entity type:Organization
Organization Name:SACKETS HARBOR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:315-646-3777
Mailing Address - Street 1:107 BARRACKS DR
Mailing Address - Street 2:
Mailing Address - City:SACKETS HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:13685-9530
Mailing Address - Country:US
Mailing Address - Phone:315-646-3777
Mailing Address - Fax:315-646-3890
Practice Address - Street 1:107 BARRACKS DR
Practice Address - Street 2:
Practice Address - City:SACKETS HARBOR
Practice Address - State:NY
Practice Address - Zip Code:13685-9530
Practice Address - Country:US
Practice Address - Phone:315-646-3777
Practice Address - Fax:315-646-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5805783OtherGHI
NYP01000796OtherBLUECROSS
NY98L1470OtherMVP
NY5805783OtherGHI
NYP01000796OtherBLUECROSS
NYDD3097Medicare UPIN
NYAA1406Medicare ID - Type Unspecified