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General NPI Number Information
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NPI Number | 1841343621
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Entity Type | Organization
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Legal Business Name | SPINA CHIROPRACTIC OFFICE PC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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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 | 845-292-2225
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Fax | 845-292-8832
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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 | 845-292-2225
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Fax | 845-292-8832
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS MARK A SPINA
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Credential | D.C.
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Telephone | 845-292-2225
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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 | X3711
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License Number State | NY
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