Provider Demographics
NPI:1013003912
Name:SRN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:SRN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-328-8077
Mailing Address - Street 1:174 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4803
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:6517 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6248
Practice Address - Country:US
Practice Address - Phone:718-497-1150
Practice Address - Fax:718-417-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006877-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07869OtherGHI MEDICARE
NYXDWQZ1Medicare PIN