Healthcare Provider Details

I. General information

NPI: 1629603881
Provider Name (Legal Business Name): DYNAMIC CHIROPRACTIC AND PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7883 SENECA TURNPIKE, CLINTON
CLINTON NY
13323
US

IV. Provider business mailing address

7883 SENECA TURNPIKE, CLINTON
NEW YORK NY
13323
US

V. Phone/Fax

Practice location:
  • Phone: 315-404-4782
  • Fax: 315-282-2337
Mailing address:
  • Phone: 315-404-4782
  • Fax: 315-282-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSE VELASQUEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 201-641-2125