Provider Demographics
NPI:1457521197
Name:SPECIFIC CHIROPRACTIC
Entity Type:Organization
Organization Name:SPECIFIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WEHRENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-373-1877
Mailing Address - Street 1:1673 ROUTE 9
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4397
Mailing Address - Country:US
Mailing Address - Phone:518-373-1833
Mailing Address - Fax:518-371-3939
Practice Address - Street 1:1673 ROUTE 9
Practice Address - Street 2:SUITE 2
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4397
Practice Address - Country:US
Practice Address - Phone:518-373-1833
Practice Address - Fax:518-371-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty