Provider Demographics
NPI:1568653418
Name:CLIFTON CHIROPRACTIC NUTRITION & WELLNESS PLLC
Entity Type:Organization
Organization Name:CLIFTON CHIROPRACTIC NUTRITION & WELLNESS PLLC
Other - Org Name:CLIFTON CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:RAYHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-383-3700
Mailing Address - Street 1:865 ROUTE 146
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3804
Mailing Address - Country:US
Mailing Address - Phone:518-383-3700
Mailing Address - Fax:518-383-4158
Practice Address - Street 1:865 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3804
Practice Address - Country:US
Practice Address - Phone:518-383-3700
Practice Address - Fax:518-383-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003944-1111N00000X
NYX004051-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1623Medicare PIN