Provider Demographics
NPI:1932348323
Name:CHIROPRACTIC CARE & SPORTS REHAB OF CLIFTON PARK, PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE & SPORTS REHAB OF CLIFTON PARK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-348-0287
Mailing Address - Street 1:1603 ROUTE 9
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4380
Mailing Address - Country:US
Mailing Address - Phone:518-348-0287
Mailing Address - Fax:
Practice Address - Street 1:1603 ROUTE 9
Practice Address - Street 2:SUITE #1
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4380
Practice Address - Country:US
Practice Address - Phone:518-348-0287
Practice Address - Fax:518-348-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty