Provider Demographics
NPI:1982909073
Name:TOLL GATE CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:TOLL GATE CHIROPRACTIC LTD
Other - Org Name:DR. DAVID DWYER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-8154
Mailing Address - Street 1:189 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4445
Mailing Address - Country:US
Mailing Address - Phone:401-738-8154
Mailing Address - Fax:401-732-1301
Practice Address - Street 1:189 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4445
Practice Address - Country:US
Practice Address - Phone:401-738-8154
Practice Address - Fax:401-732-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC 258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI359009052Medicare PIN