Healthcare Provider Details

I. General information

NPI: 1992061600
Provider Name (Legal Business Name): LOUIS J. SPAGNOLA DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 DANBURY RD
RIDGEFIELD CT
06877-4069
US

IV. Provider business mailing address

1145 ROUTE 55 STE 4
LAGRANGEVILLE NY
12540-5047
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-5200
  • Fax:
Mailing address:
  • Phone: 845-452-5200
  • Fax: 845-483-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberX005054-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number000737
License Number StateCT

VIII. Authorized Official

Name: LOUIS SPAGNOLA
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 845-452-5200