=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053588863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ANGELA A. FAIN DC, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 05/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 490 ROUTE 304
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-3040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-634-7800
-----------------------------------------------------
Fax | 845-639-1972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 490 ROUTE 304
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-3040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-634-7800
-----------------------------------------------------
Fax | 845-639-1972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANGELA FAIN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 845-634-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 011522
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------