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General NPI Number Information
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NPI Number | 1003239922
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Entity Type | Organization
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Legal Business Name | CHIROSPORT AND SPINE, LLC
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 421 E. MAIN ST.
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City | ENDICOTT
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State | NY
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Zip | 13760
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Country | US
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Telephone | 607-321-7674
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Fax | 855-890-7728
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Provider Business Mailing Address
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Address Line | 3103 CHATHAM RD.
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City | ENDWELL
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State | NY
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Zip | 13760
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Country | US
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Telephone | 607-321-7674
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. BRIAN L. BALDIA
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Credential | D.C.
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Telephone | 267-253-7808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC007952L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X012250-1
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License Number State | NY
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