Provider Demographics
NPI:1477602167
Name:VALLEY CHIROPRACTIC ASSOC PC
Entity Type:Organization
Organization Name:VALLEY CHIROPRACTIC ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:G
Authorized Official - Last Name:INCORVAIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-635-8484
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:1579 MAIN ST
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-0714
Mailing Address - Country:US
Mailing Address - Phone:845-635-8484
Mailing Address - Fax:845-635-8491
Practice Address - Street 1:1579 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-0714
Practice Address - Country:US
Practice Address - Phone:845-635-8484
Practice Address - Fax:845-635-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU91451Medicare UPIN