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General NPI Number Information
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NPI Number | 1407089634
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Entity Type | Organization
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Legal Business Name | ADVANCE CHIROPRACTIC P C
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 221 S MIDDLETOWN RD
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City | NANUET
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State | NY
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Zip | 10954-3325
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Country | US
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Telephone | 845-623-0026
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Fax | 845-623-0096
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Provider Business Mailing Address
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Address Line | 221 S MIDDLETOWN RD
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City | NANUET
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State | NY
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Zip | 10954-3325
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Country | US
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Telephone | 845-623-0026
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Fax | 845-623-0096
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM RONALD JOHNSON
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Credential | D.C.
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Telephone | 845-623-0026
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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 | X008833
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License Number State | NY
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