Provider Demographics
NPI:1669759312
Name:WITCHLEY CHIROPRACTIC AND ACUPUNCTURE P.C.
Entity type:Organization
Organization Name:WITCHLEY CHIROPRACTIC AND ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WITCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC LAC
Authorized Official - Phone:315-337-0763
Mailing Address - Street 1:734 ERIE BLVD W
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3946
Mailing Address - Country:US
Mailing Address - Phone:315-337-0763
Mailing Address - Fax:315-337-7973
Practice Address - Street 1:734 ERIE BLVD W
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3946
Practice Address - Country:US
Practice Address - Phone:315-337-0763
Practice Address - Fax:315-337-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003867171100000X
NYX4401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26648Medicare UPIN