Provider Demographics
NPI:1801394804
Name:CHIROPRACTIC WELLNESS OF MIDDLETOWN, P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS OF MIDDLETOWN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-342-0000
Mailing Address - Street 1:201 DOLSON AVE STE H100
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 DOLSON AVE STE H100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-342-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX006642OtherLICENS