=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750932174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE CHIROPRACTIC AND ACUPUNCTURE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2019
-----------------------------------------------------
Last Update Date | 09/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 CHURCH ST STE B
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-684-1800
-----------------------------------------------------
Fax | 914-684-1801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 CHURCH ST STE B
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-1519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-684-1800
-----------------------------------------------------
Fax | 914-684-1801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREN SAID
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 914-413-4263
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------