=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619163292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID-HUDSON CHIROPRACTIC HEALTH SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2007
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1033 ROUTE 82
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-6166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-221-3555
-----------------------------------------------------
Fax | 845-226-3307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 86
-----------------------------------------------------
City | HOPEWELL JUNCTION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12533-0086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-221-3555
-----------------------------------------------------
Fax | 845-226-3307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH OLMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-221-3555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X009583
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------