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General NPI Number Information
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NPI Number | 1104087667
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Entity Type | Organization
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Legal Business Name | CHASE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 17 PINE ST. 1 IRONGATE CENTER SUITE 3
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City | GLENS FALLS
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State | NY
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Zip | 12801
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Country | US
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Telephone | 518-743-0163
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Fax | 518-743-0973
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Provider Business Mailing Address
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Address Line | 17 PINE ST. 1 IRONGATE CENTER SUITE 3
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City | GLENS FALLS
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State | NY
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Zip | 12801
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Country | US
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Telephone | 518-743-0163
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Fax | 518-743-0973
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW D CHASE
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Credential | DC
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Telephone | 518-743-0163
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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 | X008066-1
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License Number State | NY
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