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General NPI Number Information
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NPI Number | 1639379464
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC WELLNESS OF NORTHERN NEW YORK, PLLC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 107 BARRACKS DR
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City | SACKETS HARBOR
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State | NY
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Zip | 13685-9530
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Country | US
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Telephone | 315-646-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 107 BARRACKS DR
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City | SACKETS HARBOR
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State | NY
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Zip | 13685-9530
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Country | US
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Telephone | 315-646-3777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE LEIGH LUNDY
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Credential | D.C.
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Telephone | 315-646-3777
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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 | X011402-1
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License Number State | NY
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