=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740574078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTCHESTER CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2011
-----------------------------------------------------
Last Update Date | 06/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 83 MONTGOMERY AVE SUITE A
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-961-7575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 MONTGOMERY AVE SUITE A
-----------------------------------------------------
City | SCARSDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10583-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-961-7575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. JUDD P DAVIS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 914-961-7575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN0400X
-----------------------------------------------------
Taxonomy Name | Neurology Chiropractor
-----------------------------------------------------
License Number | X9805
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------