Healthcare Provider Details

I. General information

NPI: 1982996336
Provider Name (Legal Business Name): WOROB CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 TRUMANSBURG RD
ITHACA NY
14850-1314
US

IV. Provider business mailing address

1212 TRUMANSBURG RD
ITHACA NY
14850-1314
US

V. Phone/Fax

Practice location:
  • Phone: 607-288-2205
  • Fax: 607-793-9464
Mailing address:
  • Phone: 607-288-2205
  • Fax: 607-793-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011697
License Number StateNY

VIII. Authorized Official

Name: AMMITAI WOROB
Title or Position: OWNER
Credential: D. C.
Phone: 607-288-2205