Provider Demographics
NPI:1558453233
Name:HARGIS, CALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:HARGIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1025
Mailing Address - Country:US
Mailing Address - Phone:845-986-5500
Mailing Address - Fax:845-986-6627
Practice Address - Street 1:40 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1025
Practice Address - Country:US
Practice Address - Phone:845-986-5500
Practice Address - Fax:845-986-6627
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002610-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP470502OtherOXFORD
NYT52252Medicare UPIN
NYP470502OtherOXFORD