Provider Demographics
NPI:1558438218
Name:FAMILY HEALTH & SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY HEALTH & SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-456-8805
Mailing Address - Street 1:62 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-9778
Mailing Address - Country:US
Mailing Address - Phone:518-869-1709
Mailing Address - Fax:
Practice Address - Street 1:2563 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-9400
Practice Address - Country:US
Practice Address - Phone:518-456-8805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009338-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU76688Medicare UPIN
NYBA0301Medicare ID - Type UnspecifiedCHIROPRACTIC