Basic Information
| Provider Information | |||||||||
| NPI: | 1871825521 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHIROPRACTIC PAIN-WELLNESS CARE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154226828 | ||||||||
| FaxNumber: | 3152952208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154226828 | ||||||||
| FaxNumber: | 3152952208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 02/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | LODI | ||||||||
| AuthorizedOfficialFirstName: | SHAHNAZ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3154226828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | X010673-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.