Provider Demographics
NPI:1063507903
Name:VIOLE, JOHN A (CH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:VIOLE
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 BATCHELDER STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-934-0007
Mailing Address - Fax:718-934-0097
Practice Address - Street 1:2158 BATCHELDER STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-934-0007
Practice Address - Fax:718-934-0097
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0048051111N00000X
NJ4906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX29551Medicare PIN
NYT52935Medicare UPIN