Michael James Demianenko, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

X008072-1 Issued in NY

Practice address

16163 County Route 156
Watertown, NY 13601-5746

Phone

(315) 779-2828

Fax

(315) 782-5813

NPI assigned

Nov 16, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Chiropractic Care, PC

  • Chiropractor
  • Watertown, NY
  • NPI 1528015377
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1831262724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16163 COUNTY ROUTE 156",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015746",
            "telephone_number": "315-779-2828",
            "fax_number": "315-782-5813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16163 COUNTY ROUTE 156",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015746",
            "telephone_number": "315-779-2828",
            "fax_number": "315-782-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMIANENKO",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X008072-1",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC006671-L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE WORKERS COMPENSA",
            "identifier": "C08072-3W",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER ID#",
            "identifier": "10925625",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Shannon Demarco, OTR/L
• Charles Dembowski, OD
• Kelsy Dennie, LMSW
• Krista Lyn Dennis, PT
• Dental Devices, PC (Dental Sleep Associates)
• Angela Denton
• Dermatology & Plastic Surgery of Northern New York PC

• Chiropractor in Watertown, NY
• Providers in Watertown, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.