=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366034704
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORD CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2021
-----------------------------------------------------
Last Update Date | 02/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 JUNE RD
-----------------------------------------------------
City | NORTH SALEM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10560-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-410-0031
-----------------------------------------------------
Fax | 845-335-4622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 499 E BRANCH RD
-----------------------------------------------------
City | PATTERSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12563-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-439-6398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRISTINA FORD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 401-439-6398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------