=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609528306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPOWER CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2022
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52A BABBITT RD
-----------------------------------------------------
City | BEDFORD HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10507-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-984-9849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 ANNAROCK DR
-----------------------------------------------------
City | SOMERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10589-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-984-9849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIEL GIFEISMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 860-306-4690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------