Provider Demographics
NPI:1104035310
Name:FAMILY CHIROPRACTOR
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATWINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANJAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-357-3262
Mailing Address - Street 1:56 CLIFTON COUNTRY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3995
Mailing Address - Country:US
Mailing Address - Phone:518-357-3262
Mailing Address - Fax:518-357-3263
Practice Address - Street 1:56 CLIFTON COUNTRY RD STE 104
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3995
Practice Address - Country:US
Practice Address - Phone:518-357-3262
Practice Address - Fax:518-357-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVX012086-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHQRMedicare ID - Type Unspecified