Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12951-1 | NY |
N | 111NP0017X | Pediatric Chiropractor | 12951-1 | NY |
NPI | 1770010803 |
---|---|
Provider Name | Dr. Carolyn Driscoll |
First Address | Wilton, NY 12831-2526 |
Second Address | Gansevoort, NY 12831-2526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2017 |
Last Update Date | 19/05/2017 |