=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942463922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMODEO CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2008
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 ALL ANGELS HILL RD
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-298-7105
-----------------------------------------------------
Fax | 845-298-7138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 ALL ANGELS HILL RD
-----------------------------------------------------
City | WAPPINGERS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12590-3322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-298-7105
-----------------------------------------------------
Fax | 845-298-7138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS J AMODEO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 845-298-7105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | X004576-7
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------