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General NPI Number Information
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NPI Number | 1104013366
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH CHIROPRACTIC OF WESTCHESTER, PLLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 111 S RIDGE ST SUITE 301
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City | PORT CHESTER
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State | NY
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Zip | 10573-2837
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Country | US
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Telephone | 914-934-2000
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Fax | 914-206-3627
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Provider Business Mailing Address
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Address Line | 111 S RIDGE ST SUITE 301
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City | PORT CHESTER
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State | NY
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Zip | 10573-2837
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Country | US
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Telephone | 914-934-2000
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Fax | 914-206-3627
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SUSAN CAROL FRIEDMAN
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Credential | D. C.
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Telephone | 914-934-2000
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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 | X0055251
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License Number State | NY
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