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General NPI Number Information
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NPI Number | 1033779822
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Entity Type | Organization
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Legal Business Name | VANDERBROOK CHIROPRACTIC
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 26 EAST MAIN STREET SUITE 201
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-0583
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Country | US
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Telephone | 315-906-4042
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Fax | 315-906-4268
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Provider Business Mailing Address
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Address Line | PO BOX 583
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City | CLIFTON SPRINGS
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State | NY
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Zip | 14432-0583
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Country | US
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Telephone |
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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 | GREGORY VANDERBROOK
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Credential | DC
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Telephone | 315-906-4042
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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 |
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License Number State |
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