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General NPI Number Information
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NPI Number | 1104910967
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Entity Type | Organization
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Legal Business Name | TERESA M BACH CARTHAGE FAMILY CHIROPRAC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20284 COUNTY ROUTE 45
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City | CARTHAGE
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State | NY
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Zip | 13619-9502
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Country | US
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Telephone | 315-493-0305
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Fax | 315-493-0305
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | CARTHAGE
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State | NY
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Zip | 13619-0070
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Country | US
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Telephone | 315-493-0305
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Fax | 315-493-0305
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. TERESA MAE BACH
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Credential | D.C.
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Telephone | 315-493-0305
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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 | X0040721
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License Number State | NY
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