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General NPI Number Information
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NPI Number | 1871770008
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Entity Type | Organization
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Legal Business Name | CAPITAL REGION SPINAL REHABILITATION AND CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 8 CENTURY HILL DR SUITE 202
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City | LATHAM
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State | NY
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Zip | 12110-2193
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Country | US
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Telephone | 518-782-5060
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Fax | 518-782-5063
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Provider Business Mailing Address
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Address Line | 8 CENTURY HILL DR SUITE 202
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City | LATHAM
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State | NY
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Zip | 12110-2193
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Country | US
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Telephone | 518-782-5060
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Fax | 518-782-5063
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN P MILHAM
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Credential | D.C.
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Telephone | 518-782-5060
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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 | X011338
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License Number State | NY
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