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General NPI Number Information
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NPI Number | 1235396193
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Entity Type | Organization
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Legal Business Name | TRINITY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 4583 NORTH ST
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City | JAMESVILLE
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State | NY
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Zip | 13078-9461
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Country | US
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Telephone | 315-469-9120
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Fax | 315-469-9124
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Provider Business Mailing Address
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Address Line | 4583 NORTH ST
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City | JAMESVILLE
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State | NY
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Zip | 13078-9461
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Country | US
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Telephone | 315-469-9120
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Fax | 315-469-9124
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DENISE L MIRANDA
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Credential | D.C.
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Telephone | 315-469-9120
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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 | X010412-2
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License Number State | NY
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