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General NPI Number Information
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NPI Number | 1548533649
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Entity Type | Organization
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Legal Business Name | VAN AMBERG FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 606 METACOM AVE SUITE 5
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City | WARREN
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State | RI
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Zip | 02885-2837
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Country | US
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Telephone | 401-245-6294
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Fax |
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Provider Business Mailing Address
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Address Line | 606 METACOM AVE SUITE 5
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City | WARREN
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State | RI
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Zip | 02885-2837
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Country | US
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Telephone | 401-245-6294
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID J VAN AMBERG
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Credential | D.C.
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Telephone | 401-245-6294
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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 | DC00421
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License Number State | RI
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