Healthcare Provider Details

I. General information

NPI: 1710963764
Provider Name (Legal Business Name): TINA MARIE NAGLE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W WATER ST SUITE 101
PAINTED POST NY
14870-1131
US

IV. Provider business mailing address

88 ROTARY ROAD EXT
CHEMUNG NY
14825-9633
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-1552
  • Fax: 607-936-1559
Mailing address:
  • Phone: 607-529-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX007751-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005900L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: