Healthcare Provider Details

I. General information

NPI: 1982909073
Provider Name (Legal Business Name): TOLL GATE CHIROPRACTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 TOLL GATE RD
WARWICK RI
02886-4445
US

IV. Provider business mailing address

189 TOLL GATE RD
WARWICK RI
02886-4445
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-8154
  • Fax: 401-732-1301
Mailing address:
  • Phone: 401-738-8154
  • Fax: 401-732-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 258
License Number StateRI

VIII. Authorized Official

Name: MRS. AMANDA MEDEIROS
Title or Position: BILLING MANAGER
Credential:
Phone: 401-738-8154