Provider Demographics
NPI:1598169674
Name:TWIN PINE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TWIN PINE FAMILY CHIROPRACTIC LLC
Other - Org Name:TWIN PINE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HULBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-853-1567
Mailing Address - Street 1:592 N GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SPRAKERS
Mailing Address - State:NY
Mailing Address - Zip Code:12166-3202
Mailing Address - Country:US
Mailing Address - Phone:518-922-8624
Mailing Address - Fax:
Practice Address - Street 1:2609A STATE HIGHWAY 30A
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068-5955
Practice Address - Country:US
Practice Address - Phone:518-853-1567
Practice Address - Fax:518-853-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00104411OtherRAIL ROAD MEDICARE
NYX6R72OtherEMPIRE BLUE CROSS
NY10057726OtherCDPHP
NY431905082-01OtherBLUE SHIELD OF NORTHEAST
NYC10120-6BOtherWORKERS COMPENSATION
NYNY10120OtherMVP
NY431905082-01OtherBLUE SHIELD OF NORTHEAST
NYNY10120OtherMVP