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General NPI Number Information
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NPI Number | 1164615399
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Entity Type | Organization
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Legal Business Name | PORT JERVIS CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 27 E MAIN ST
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City | PORT JERVIS
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State | NY
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Zip | 12771-1924
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Country | US
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Telephone | 845-858-8000
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Fax | 845-858-8006
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Provider Business Mailing Address
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Address Line | 27 E MAIN ST
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City | PORT JERVIS
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State | NY
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Zip | 12771-1924
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Country | US
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Telephone | 845-858-8000
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Fax | 845-858-8006
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH J SPANO
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Credential | DC
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Telephone | 845-858-8000
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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 | X010835
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License Number State | NY
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