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General NPI Number Information
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NPI Number | 1669759312
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Entity Type | Organization
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Legal Business Name | WITCHLEY CHIROPRACTIC AND ACUPUNCTURE P.C.
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 734 ERIE BLVD W
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City | ROME
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State | NY
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Zip | 13440-3946
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Country | US
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Telephone | 315-337-0763
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Fax | 315-337-7973
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Provider Business Mailing Address
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Address Line | 734 ERIE BLVD W
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City | ROME
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State | NY
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Zip | 13440-3946
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Country | US
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Telephone | 315-337-0763
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Fax | 315-337-7973
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY FREDERICK WITCHLEY
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Credential | D.C. L.AC.
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Telephone | 315-337-0763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003867
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X4401
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License Number State | NY
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