Provider Demographics
NPI:1053636647
Name:STATEN ISLAND CHIROPRACTIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:STATEN ISLAND CHIROPRACTIC ASSOCIATES, P.C.
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-667-2190
Mailing Address - Street 1:2052 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2548
Mailing Address - Country:US
Mailing Address - Phone:718-667-2190
Mailing Address - Fax:718-667-7279
Practice Address - Street 1:2052 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2548
Practice Address - Country:US
Practice Address - Phone:718-667-2190
Practice Address - Fax:718-667-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008612-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty