Healthcare Provider Details

I. General information

NPI: 1104035310
Provider Name (Legal Business Name): FAMILY CHIROPRACTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CLIFTON COUNTRY RD STE 104
CLIFTON PARK NY
12065-3995
US

IV. Provider business mailing address

56 CLIFTON COUNTRY RD STE 104
CLIFTON PARK NY
12065-3995
US

V. Phone/Fax

Practice location:
  • Phone: 518-357-3262
  • Fax: 518-357-3263
Mailing address:
  • Phone: 518-357-3262
  • Fax: 518-357-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberX012086-1
License Number StateNV

VIII. Authorized Official

Name: DR. SATWINDER DHANJAL
Title or Position: OWNER
Credential: D.C.
Phone: 518-357-3262