Provider Demographics
NPI:1336606680
Name:SMALDONE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SMALDONE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-750-6913
Mailing Address - Street 1:12 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3810
Mailing Address - Country:US
Mailing Address - Phone:845-750-6913
Mailing Address - Fax:845-750-6510
Practice Address - Street 1:12 JOHN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3810
Practice Address - Country:US
Practice Address - Phone:845-750-6913
Practice Address - Fax:845-750-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12274847OtherCAQH
NYC11297-1OtherWORKER COMP
NYX011297OtherLICENSE #