Healthcare Provider Details

I. General information

NPI: 1871553800
Provider Name (Legal Business Name): CHARLES SHERWOOD EMMONS III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2567 ROUTE 55
POUGHQUAG NY
12570-5106
US

IV. Provider business mailing address

2567 ROUTE 55
POUGHQUAG NY
12570-5106
US

V. Phone/Fax

Practice location:
  • Phone: 845-724-5096
  • Fax: 845-724-8338
Mailing address:
  • Phone: 845-724-5096
  • Fax: 845-724-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008041-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: