Individual
CHRISTINE BACKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TOD
Contact information
Practice address
10 MAIN STREET, WADDINGTON, NY 13694-0249
(315) 388-7703
(315) 388-4707
Mailing address
PO BOX 249, WADDINGTON, NY 13694-0249
(315) 388-7703
(315) 388-4707
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
263303081
NY
174400000X
Specialist
Primary
523830111
NY
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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