Provider Demographics
NPI:1871703231
Name:FALLON, JOAN M (DC)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:FALLON
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 1:1234 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1068
Mailing Address - Country:US
Mailing Address - Phone:914-779-9300
Mailing Address - Fax:914-779-1148
Practice Address - Street 1:1234 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1068
Practice Address - Country:US
Practice Address - Phone:914-779-9300
Practice Address - Fax:914-779-1148
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003594111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
T52497Medicare UPIN
NYX19931Medicare ID - Type Unspecified