1982635728 NPI number — CHIROPRACTIC HEALTH SERVICES, PC

Table of content: (NPI 1982635728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982635728 NPI number — CHIROPRACTIC HEALTH SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC HEALTH SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEWBURGH CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982635728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 PIERCES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-3234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-561-6800
Provider Business Mailing Address Fax Number:
914-885-1091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 PIERCES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-561-6800
Provider Business Practice Location Address Fax Number:
914-885-1091
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASARO PENA
Authorized Official First Name:
JANETTE
Authorized Official Middle Name:
DIANA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-574-6396

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X009817 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C-9817-0B . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".