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General NPI Number Information
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NPI Number | 1275005118
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Entity Type | Organization
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Legal Business Name | ASW CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 13104 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-3124
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Country | US
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Telephone | 352-399-5085
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Fax | 866-402-3481
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Provider Business Mailing Address
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Address Line | 5090 NE 124TH PL
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City | OXFORD
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State | FL
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Zip | 34484-9625
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Country | US
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Telephone | 352-399-5085
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Fax | 866-402-3481
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MISS TINA SHALLONIS
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Credential |
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Telephone | 352-399-5085
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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 |
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License Number State |
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