Provider Demographics
NPI:1871553800
Name:EMMONS, CHARLES SHERWOOD III (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:SHERWOOD
Last Name:EMMONS
Suffix:III
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 1:2567 ROUTE 55
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5106
Mailing Address - Country:US
Mailing Address - Phone:845-724-5096
Mailing Address - Fax:845-724-8338
Practice Address - Street 1:2567 ROUTE 55
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5106
Practice Address - Country:US
Practice Address - Phone:845-724-5096
Practice Address - Fax:845-724-8338
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008041-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU65832Medicare UPIN
NYX-89511Medicare ID - Type Unspecified