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General NPI Number Information
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NPI Number | 1558438218
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH & SPORTS CHIROPRACTIC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2563 WESTERN AVE
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City | ALTAMONT
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State | NY
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Zip | 12009-9400
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Country | US
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Telephone | 518-456-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 62 WILLOW ST
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City | GUILDERLAND
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State | NY
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Zip | 12084-9778
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Country | US
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Telephone | 518-869-1709
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT T IRWIN
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Credential | D.C.
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Telephone | 518-456-8805
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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 | X009338-1
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License Number State | NY
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