Provider Demographics
NPI:1013261205
Name:NEW LEAF FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:NEW LEAF FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FLORANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSACN
Authorized Official - Phone:607-221-8765
Mailing Address - Street 1:149 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4131
Mailing Address - Country:US
Mailing Address - Phone:607-655-5500
Mailing Address - Fax:607-655-1960
Practice Address - Street 1:149 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4131
Practice Address - Country:US
Practice Address - Phone:607-655-5500
Practice Address - Fax:607-655-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011772-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100010474OtherMEDICARE PTAN