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General NPI Number Information
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NPI Number | 1346532090
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Entity Type | Organization
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Legal Business Name | STONE RIDGE CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 3631 MAIN STREET
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City | STONERIDGE
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State | NY
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Zip | 12484
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Country | US
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Telephone | 845-687-0088
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Fax | 845-687-0089
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Provider Business Mailing Address
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Address Line | PO BOX 514
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City | STONE RIDGE
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State | NY
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Zip | 12484-0514
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Country | US
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Telephone | 845-687-0088
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Fax | 845-687-0089
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY EDWARD DESCHENES
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Credential | D.C.
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Telephone | 845-687-0088
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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 | X008548
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License Number State | NY
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