Provider Demographics
NPI:1578736385
Name:ALISE CHIROPRACTIC HEALTH & WELLNESS, PLLC
Entity Type:Organization
Organization Name:ALISE CHIROPRACTIC HEALTH & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALISE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-227-2623
Mailing Address - Street 1:104 HALLER BLVD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3030
Mailing Address - Country:US
Mailing Address - Phone:607-227-2623
Mailing Address - Fax:833-803-3431
Practice Address - Street 1:821 CLIFF ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2097
Practice Address - Country:US
Practice Address - Phone:607-227-2623
Practice Address - Fax:833-803-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011015-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0597Medicare UPIN