=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194464610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARNEVELD FAMILY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2022
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 VANDERKEMP AVE
-----------------------------------------------------
City | BARNEVELD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-896-4338
-----------------------------------------------------
Fax | 315-896-4342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 501
-----------------------------------------------------
City | BARNEVELD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13304-0501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 131-589-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | DAVID W HELMER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 315-896-4338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------