Healthcare Provider Details

I. General information

NPI: 1669759312
Provider Name (Legal Business Name): WITCHLEY CHIROPRACTIC AND ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 ERIE BLVD W
ROME NY
13440-3946
US

IV. Provider business mailing address

734 ERIE BLVD W
ROME NY
13440-3946
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-0763
  • Fax: 315-337-7973
Mailing address:
  • Phone: 315-337-0763
  • Fax: 315-337-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX4401
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003867
License Number StateNY

VIII. Authorized Official

Name: DR. GARY FREDERICK WITCHLEY
Title or Position: PRESIDENT
Credential: D.C. L.AC.
Phone: 315-337-0763