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General NPI Number Information
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NPI Number | 1447404421
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Entity Type | Organization
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Legal Business Name | PORT CHESTER CHIROPRACTIC,P.C.
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 3000 WESTCHESTER AVENUE SUITE 203
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City | PURCHASE
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State | NY
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Zip | 10577
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Country | US
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Telephone | 914-939-0101
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Fax | 914-939-7755
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Provider Business Mailing Address
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Address Line | 3000 WESTCHESTER AVENUE SUITE 203
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City | PURCHASE
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State | NY
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Zip | 10577
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Country | US
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Telephone | 914-939-0101
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Fax | 914-939-7755
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | DR. MICHAEL JOE BARDWELL
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Credential | D.C.
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Telephone | 914-939-0101
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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 | X005541
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License Number State | NY
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