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General NPI Number Information
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NPI Number | 1700157013
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE OF HORNELL PROGRESSIVE CHIROPRACTIC REHABILITATION, P.C.
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 340 CLEVELAND AVE
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City | HORNELL
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State | NY
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Zip | 14843-1004
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Country | US
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Telephone | 607-324-2444
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Fax | 607-324-2524
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Provider Business Mailing Address
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Address Line | PO BOX 358
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City | HORNELL
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State | NY
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Zip | 14843-0358
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Country | US
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Telephone | 607-324-2444
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Fax | 607-324-2524
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | DR. SUSAN J COSGROVE
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Credential | D.C.
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Telephone | 607-324-2444
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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 | X0028931
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License Number State | NY
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