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General NPI Number Information
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NPI Number | 1992337992
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Entity Type | Organization
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Legal Business Name | SUMMIT SPORT CHIROPRACTIC
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 45 HARBOR DR
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City | STAMFORD
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State | CT
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Zip | 06902-7405
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Country | US
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Telephone | 203-539-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 22 GEORGETOWN OVAL
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City | NEW CITY
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State | NY
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Zip | 10956-6804
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Country | US
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Telephone | 845-729-0462
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Fax |
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Authorized Official
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Title or Position | ALEXIS KANTOR
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Name | ALEXIS KANTOR
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Credential | DC
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Telephone | 845-729-0462
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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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