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General NPI Number Information
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NPI Number | 1861823577
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Entity Type | Organization
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Legal Business Name | ISLAND FAMILY CHIROPRACTIC WELLNESS PLLC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 400 KINGS MALL CT
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City | KINGSTON
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State | NY
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Zip | 12401-1578
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Country | US
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Telephone | 846-663-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 62 CLOVER ST
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City | WEST HURLEY
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State | NY
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Zip | 12491-6019
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Country | US
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Telephone | 845-663-8299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLENN M. GIBSON
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Credential | D.C.
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Telephone | 845-663-8299
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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 |
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License Number State |
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