Provider Demographics
NPI:1922290485
Name:LAGRANGE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LAGRANGE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLISKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-471-7850
Mailing Address - Street 1:305 TITUSVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2917
Mailing Address - Country:US
Mailing Address - Phone:845-471-7850
Mailing Address - Fax:845-471-1022
Practice Address - Street 1:305 TITUSVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2917
Practice Address - Country:US
Practice Address - Phone:845-471-7850
Practice Address - Fax:845-471-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX29871Medicare UPIN