Provider Demographics
NPI:1295881159
Name:MIRANDA, DENISE L (DC)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:L
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4583 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9461
Mailing Address - Country:US
Mailing Address - Phone:315-469-9120
Mailing Address - Fax:315-469-9124
Practice Address - Street 1:4583 NORTH ST
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9461
Practice Address - Country:US
Practice Address - Phone:315-469-9120
Practice Address - Fax:315-469-9124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010412-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000144576OtherBCBS
NYAA1387Medicare ID - Type UnspecifiedUPSTATE MEDICARE