Provider Demographics
NPI:1255847695
Name:BKLYN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BKLYN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-316-0998
Mailing Address - Street 1:3313 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20935 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3134
Practice Address - Country:US
Practice Address - Phone:718-225-9000
Practice Address - Fax:718-352-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty