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General NPI Number Information
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NPI Number | 1730787003
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Entity Type | Organization
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Legal Business Name | CATSKILL CHIROPRACTIC DIAGNOSTICS, P.C.
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 21 MILL ST
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City | LIBERTY
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State | NY
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Zip | 12754-2010
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Country | US
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Telephone | 845-292-8810
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Fax | 845-295-9156
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Provider Business Mailing Address
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Address Line | 21 MILL ST
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City | LIBERTY
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State | NY
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Zip | 12754-2010
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Country | US
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Telephone | 845-292-8810
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Fax | 845-295-9156
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MARK SPINA
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Credential | D.C.
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Telephone | 845-292-8810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number |
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License Number State |
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