=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477279271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID HUDSON CHIROPRACTIC AND PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2022
-----------------------------------------------------
Last Update Date | 10/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 WICKHAM AVE STE 104
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-3852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-775-3625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1354 MIDLAND AVE APT 2T
-----------------------------------------------------
City | BRONXVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10708-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-418-0432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DARRIN KALOZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-418-0432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------