Provider Demographics
NPI:1053458273
Name:PAUL ANTHONY CHILLE DC & PATRICE ANNE CARROLL DC
Entity Type:Organization
Organization Name:PAUL ANTHONY CHILLE DC & PATRICE ANNE CARROLL DC
Other - Org Name:PAUL CHILLE & PATRICE CARROLL
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-587-0057
Mailing Address - Street 1:106 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6004
Mailing Address - Country:US
Mailing Address - Phone:518-587-0057
Mailing Address - Fax:
Practice Address - Street 1:106 WEST AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6004
Practice Address - Country:US
Practice Address - Phone:518-587-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6554OtherCDPHP GROUP #
NYDB9144Medicare PIN
NY6554OtherCDPHP GROUP #