Healthcare Provider Details

I. General information

NPI: 1114113230
Provider Name (Legal Business Name): CENTRAL SQUARE FAMILY CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVE
CENTRAL SQUARE NY
13036-9502
US

IV. Provider business mailing address

PO BOX 893
CENTRAL SQUARE NY
13036-0893
US

V. Phone/Fax

Practice location:
  • Phone: 315-668-3248
  • Fax: 315-676-3796
Mailing address:
  • Phone: 315-668-3248
  • Fax: 315-676-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010102-1
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL P WALSH
Title or Position: DOCTOR
Credential: DC
Phone: 315-668-3248