Provider Demographics
NPI:1750500518
Name:CHIROFIT WELLNESS CENTER
Entity Type:Organization
Organization Name:CHIROFIT WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:CAESAR
Authorized Official - Last Name:CIRIGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-294-4402
Mailing Address - Street 1:2527 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6716
Mailing Address - Country:US
Mailing Address - Phone:845-294-4402
Mailing Address - Fax:845-291-1268
Practice Address - Street 1:2527 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6716
Practice Address - Country:US
Practice Address - Phone:845-294-4402
Practice Address - Fax:845-291-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009118-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5B161Medicare UPIN
NYX5B161Medicare ID - Type UnspecifiedCHIROPRACTOR