Healthcare Provider Details

I. General information

NPI: 1760899546
Provider Name (Legal Business Name): ATLANTIC CHIROPRACTIC INJURY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BRIDLE WAY
PAWLING NY
12564-2220
US

IV. Provider business mailing address

23 BRIDLE WAY
PAWLING NY
12564-2220
US

V. Phone/Fax

Practice location:
  • Phone: 914-523-2878
  • Fax:
Mailing address:
  • Phone: 914-523-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010917-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021858-1
License Number StateNY

VIII. Authorized Official

Name: DR. LOUIS CAMPBELL
Title or Position: CHIROPRACTOR
Credential:
Phone: 914-523-2878