Provider Demographics
NPI:1750809273
Name:ADIRONDACK SPINE AND SPORTS CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ADIRONDACK SPINE AND SPORTS CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BORIS
Authorized Official - Last Name:FORLINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-741-7016
Mailing Address - Street 1:96 W NOTRE DAME ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2723
Mailing Address - Country:US
Mailing Address - Phone:845-264-1451
Mailing Address - Fax:
Practice Address - Street 1:484 GLEN ST STE B
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3194
Practice Address - Country:US
Practice Address - Phone:518-741-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396281580OtherNPI