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General NPI Number Information
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NPI Number | 1164654075
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Entity Type | Organization
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Legal Business Name | CAMPOLA CHIROPRACTIC SERVICES P.C.
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 1904 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-5662
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Country | US
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Telephone | 315-793-7455
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Fax | 866-376-6307
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Provider Business Mailing Address
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Address Line | 1904 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-5662
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Country | US
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Telephone | 315-793-7455
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Fax | 866-376-6307
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Authorized Official
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Title or Position | PRESIDENT/SECRATARY
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Name | DR. DAVID NICHOLAS CAMPOLA JR.
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Credential | D.C.
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Telephone | 315-793-7455
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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 | X009085-1
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License Number State | NY
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