=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992490510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINE VALLEY CHIROPRACTIC WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2023
-----------------------------------------------------
Last Update Date | 07/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 MILL STREET
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-531-0022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3346 SLITER HILL RD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14512-9613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-721-7424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARCELLA M BURKARD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 585-721-7424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------