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General NPI Number Information
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NPI Number | 1902446750
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Entity Type | Organization
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Legal Business Name | ENLIGHTEN CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 2 TOWER PL STE 1
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City | ALBANY
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State | NY
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Zip | 12203-3726
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Country | US
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Telephone | 518-313-6470
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Fax |
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Provider Business Mailing Address
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Address Line | 2 TOWER PL STE 1
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City | ALBANY
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State | NY
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Zip | 12203-3726
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Country | US
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Telephone | 518-313-6470
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | KERI ANN HAGENSTON
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Credential | D. C.
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Telephone | 518-313-6470
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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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