Provider Demographics
NPI:1114113230
Name:CENTRAL SQUARE FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CENTRAL SQUARE FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-668-3248
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-0893
Mailing Address - Country:US
Mailing Address - Phone:315-668-3248
Mailing Address - Fax:315-676-3796
Practice Address - Street 1:3045 EAST AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-9502
Practice Address - Country:US
Practice Address - Phone:315-668-3248
Practice Address - Fax:315-676-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010102-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7455427OtherAETNA
NY5323798OtherCIGNA
NY5897918OtherGHI
NYNY10102OtherTOTAL CARE
NY10770520OtherCAQH
NYNY10102OtherLANDMARK
NYX010102OtherRMSCO
NYP-11213126OtherMULTIPLAN
NYNY10102OtherLANDMARK