Provider Demographics
NPI:1457520082
Name:HUDSON VALLEY WELLNESS & CHIRPRACTIC, PC
Entity Type:Organization
Organization Name:HUDSON VALLEY WELLNESS & CHIRPRACTIC, PC
Other - Org Name:HUDSON VALLEY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ZWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-744-2420
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-0149
Mailing Address - Country:US
Mailing Address - Phone:845-744-2420
Mailing Address - Fax:845-744-2429
Practice Address - Street 1:103 MAPLE AVENUE
Practice Address - Street 2:RT 302
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-0149
Practice Address - Country:US
Practice Address - Phone:845-744-2420
Practice Address - Fax:845-744-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX06006-3111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX38591Medicare PIN