Individual
DR. MICHAEL JAMES DEMIANENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
16163 COUNTY ROUTE 156, WATERTOWN, NY 13601-5746
(315) 779-2828
(315) 782-5813
Mailing address
16163 COUNTY ROUTE 156, WATERTOWN, NY 13601-5746
(315) 779-2828
(315) 782-5813
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC006671-L
PA
111N00000X
Chiropractor
Primary
X008072-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10925625
CAQH PROVIDER ID#
NY
01
—
C08072-3W
NY STATE WORKERS COMPENSA
NY
Enumeration date
11/16/2006
Last updated
07/09/2007
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