Provider Demographics
NPI:1104013366
Name:BACK TO HEALTH CHIROPRACTIC OF WESTCHESTER, PLLC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC OF WESTCHESTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:914-934-2000
Mailing Address - Street 1:111 S RIDGE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2837
Mailing Address - Country:US
Mailing Address - Phone:914-934-2000
Mailing Address - Fax:914-206-3627
Practice Address - Street 1:111 S RIDGE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-2837
Practice Address - Country:US
Practice Address - Phone:914-934-2000
Practice Address - Fax:914-206-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0055251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXCWPM1Medicare PIN