Provider Demographics
NPI:1194011882
Name:WHIPPLE CITY FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WHIPPLE CITY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PASOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-810-2045
Mailing Address - Street 1:128 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-1215
Mailing Address - Country:US
Mailing Address - Phone:518-692-8584
Mailing Address - Fax:518-692-8597
Practice Address - Street 1:128 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-1215
Practice Address - Country:US
Practice Address - Phone:518-692-8584
Practice Address - Fax:518-692-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA5568OtherMEDICARE PTAN
NY1013056852OtherINDIVIDUAL NPI